MEDICARE: LAGWENDA HILL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist	MPSS-STNPX	CA

General Provider Information

NPI Number	:	1013432731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAGWENDA HILL

Provider Business Mailing Address
First Line	:	3125 MYERS ST
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92503-5527
Country	:	US
Telephone Number	:	951-358-5862
Fax Number	:

Provider Business Practice Location Address
First Line	:	3125 MYERS ST
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92503-5527
Country	:	US
Telephone Number	:	951-358-5862
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2017
Last Update Date	:	02/05/2026

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Directions to “ LAGWENDA HILL ” Practice Location

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