Provider Demographics
NPI:1619032513
Name:LAGUNA, ERICA MARIA (MA)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:MARIA
Last Name:LAGUNA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 YOUTH WAY
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-4107
Mailing Address - Country:US
Mailing Address - Phone:714-871-9264
Mailing Address - Fax:714-578-0286
Practice Address - Street 1:2050 YOUTH WAY
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-4107
Practice Address - Country:US
Practice Address - Phone:714-871-9264
Practice Address - Fax:714-578-0286
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF49647106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist