Provider Demographics
NPI:1134723281
Name:LAGUNA-MIRANDA, ROSSANA MARITZA
Entity type:Individual
Prefix:
First Name:ROSSANA
Middle Name:MARITZA
Last Name:LAGUNA-MIRANDA
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 1:5585 GOLDEN GATE PKWY
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34116-7547
Mailing Address - Country:US
Mailing Address - Phone:239-353-8770
Mailing Address - Fax:238-353-6735
Practice Address - Street 1:5585 GOLDEN GATE PKWY
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34116-7547
Practice Address - Country:US
Practice Address - Phone:239-353-8770
Practice Address - Fax:239-353-6735
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-29
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS421281835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PS42128OtherFLORIDA HEALTH DEPARTMENT