Provider Demographics
NPI:1245096601
Name:LAGOW, DANIEL (PSYCHIATRIC TECHNICI)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:LAGOW
Suffix:
Gender:M
Credentials:PSYCHIATRIC TECHNICI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8736 EL VERANO AVE
Mailing Address - Street 2:
Mailing Address - City:ELVERTA
Mailing Address - State:CA
Mailing Address - Zip Code:95626-9591
Mailing Address - Country:US
Mailing Address - Phone:559-350-2029
Mailing Address - Fax:
Practice Address - Street 1:8736 EL VERANO AVE
Practice Address - Street 2:
Practice Address - City:ELVERTA
Practice Address - State:CA
Practice Address - Zip Code:95626-9591
Practice Address - Country:US
Practice Address - Phone:559-350-2029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-23
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35075167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician