MEDICARE: LAGUNA HEALTH & WELLNESS

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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1265943070
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAGUNA HEALTH & WELLNESS

Provider Business Mailing Address
First Line	:	24351 MOULTON PKWY
Second Line	:
City	:	LAGUNA WOODS
State	:	CA
Zip	:	92637-3352
Country	:	US
Telephone Number	:	949-232-1393
Fax Number	:

Provider Business Practice Location Address
First Line	:	24351 MOULTON PKWY
Second Line	:
City	:	LAGUNA WOODS
State	:	CA
Zip	:	92637-3352
Country	:	US
Telephone Number	:	949-542-6215
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DARLA LEVEQUE
Credential	:
Telephone Number	:	949-232-1393

Provider Enumeration Date	:	10/19/2017
Last Update Date	:	04/02/2018

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Directions to “LAGUNA HEALTH & WELLNESS ” Practice Location

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