Provider Demographics
NPI:1689726663
Name:LAGUNZAD-EVENHUIS, VICTORIA P (DO)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:P
Last Name:LAGUNZAD-EVENHUIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12018
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34101-2018
Mailing Address - Country:US
Mailing Address - Phone:239-262-5770
Mailing Address - Fax:
Practice Address - Street 1:1351 PINE ST
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34104-4260
Practice Address - Country:US
Practice Address - Phone:239-262-5770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL058743207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA47930ZMedicare PIN
G10080Medicare UPIN