Provider Demographics
NPI:1629854989
Name:SANDOVAL LAGUNA, MILAGRO SELENA
Entity Type:Individual
Prefix:
First Name:MILAGRO
Middle Name:SELENA
Last Name:SANDOVAL LAGUNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 FOXVALE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-6150
Mailing Address - Country:US
Mailing Address - Phone:702-619-1859
Mailing Address - Fax:702-463-0104
Practice Address - Street 1:417 FOXVALE AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-6150
Practice Address - Country:US
Practice Address - Phone:170-261-9185
Practice Address - Fax:702-463-0104
Is Sole Proprietor?:No
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant