Provider Demographics
NPI:1649829151
Name:LAGOS NAVARRO, EDITH GUADALUPE (MA)
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:GUADALUPE
Last Name:LAGOS NAVARRO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7045 HAWTHORN AVE APT 101
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-6900
Mailing Address - Country:US
Mailing Address - Phone:323-580-7716
Mailing Address - Fax:
Practice Address - Street 1:21520 PIONEER BLVD STE 203
Practice Address - Street 2:
Practice Address - City:HAWAIIAN GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90716-2601
Practice Address - Country:US
Practice Address - Phone:562-865-3644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist