Provider Demographics
NPI:1881449452
Name:LAGUITAN, GUSSIE (RN)
Entity type:Individual
Prefix:
First Name:GUSSIE
Middle Name:
Last Name:LAGUITAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16733 TARANO LN
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92551-7411
Mailing Address - Country:US
Mailing Address - Phone:951-214-9081
Mailing Address - Fax:
Practice Address - Street 1:16733 TARANO LN
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92551-7411
Practice Address - Country:US
Practice Address - Phone:951-214-9081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95228578163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse