Healthcare Provider Details

I. General information

NPI: 1285542522
Provider Name (Legal Business Name): ALICIA LAGENDIJK RN, PHN, CBCN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 CAMPUS POINT DR FL 3
LA JOLLA CA
92093-1350
US

IV. Provider business mailing address

9400 CAMPUS POINT DR FL 3
LA JOLLA CA
92093-1350
US

V. Phone/Fax

Practice location:
  • Phone: 858-249-3245
  • Fax:
Mailing address:
  • Phone: 858-249-3245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number95109351
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: