Provider Demographics
NPI:1629449228
Name:LAGUNA, MILO A
Entity Type:Individual
Prefix:
First Name:MILO
Middle Name:A
Last Name:LAGUNA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6741 STATE HIGHWAY 49
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:CA
Mailing Address - Zip Code:95623-4555
Mailing Address - Country:US
Mailing Address - Phone:530-919-8903
Mailing Address - Fax:
Practice Address - Street 1:6741 STATE HIGHWAY 49
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:CA
Practice Address - Zip Code:95623
Practice Address - Country:US
Practice Address - Phone:530-919-8903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)