Provider Demographics
NPI:1831817899
Name:GILMORE, LAGUNDA L
Entity type:Individual
Prefix:
First Name:LAGUNDA
Middle Name:L
Last Name:GILMORE
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 1:8521 BLANCO RD # 2-167
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-3063
Mailing Address - Country:US
Mailing Address - Phone:210-772-0357
Mailing Address - Fax:
Practice Address - Street 1:1 HAVEN FOR HOPE WAY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-1266
Practice Address - Country:US
Practice Address - Phone:210-772-0357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide