Provider Demographics
NPI:1750874996
Name:SAGUN, LADY MARY LHAINE ESCOTO
Entity type:Individual
Prefix:
First Name:LADY MARY LHAINE
Middle Name:ESCOTO
Last Name:SAGUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LADY MARY LHAINE
Other - Middle Name:PARAS
Other - Last Name:ESCOTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1550 PACHINO CIR. APT. G
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91320
Mailing Address - Country:US
Mailing Address - Phone:773-677-2852
Mailing Address - Fax:
Practice Address - Street 1:1550 PACHINO CIRCLE APT G
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91320
Practice Address - Country:US
Practice Address - Phone:773-677-2852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA737399163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical