Provider Demographics
NPI:1720650112
Name:LAGUNA, ELVIRA ARLENE
Entity Type:Individual
Prefix:
First Name:ELVIRA
Middle Name:ARLENE
Last Name:LAGUNA
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 1:1800 S NELSON ST APT 164
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91792-1434
Mailing Address - Country:US
Mailing Address - Phone:714-718-4159
Mailing Address - Fax:
Practice Address - Street 1:670 W BASELINE RD
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-1492
Practice Address - Country:US
Practice Address - Phone:909-741-7124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator