Healthcare Provider Details

I. General information

NPI: 1235047887
Provider Name (Legal Business Name): GENNINE LAGMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 W OLIVE AVE
BURBANK CA
91506-2438
US

IV. Provider business mailing address

9114 N NILO LN
PANORAMA CITY CA
91402-1963
US

V. Phone/Fax

Practice location:
  • Phone: 818-729-5591
  • Fax:
Mailing address:
  • Phone: 818-729-5591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number38119
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: