Healthcare Provider Details

I. General information

NPI: 1417016155
Provider Name (Legal Business Name): JOSE ERIBERTO LAGUNDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 08/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 SAN DIMAS ST SUITE 14
BAKERSFIELD CA
93301-1661
US

IV. Provider business mailing address

11306 CRABBET PARK DR
BAKERSFIELD CA
93311-9226
US

V. Phone/Fax

Practice location:
  • Phone: 661-371-2810
  • Fax: 661-371-2811
Mailing address:
  • Phone: 661-664-7641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC51020
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: