Provider Demographics
NPI:1245705219
Name:LAGOR, JESSICA (MIDWIFE)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:LAGOR
Suffix:
Gender:F
Credentials:MIDWIFE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 RUDIN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89124-9243
Mailing Address - Country:US
Mailing Address - Phone:702-271-6475
Mailing Address - Fax:702-829-5252
Practice Address - Street 1:979 MONTE DE ORO AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89183-4669
Practice Address - Country:US
Practice Address - Phone:702-271-6475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175M00000XOther Service ProvidersMidwife, LayGroup - Single Specialty