Healthcare Provider Details

I. General information

NPI: 1467102723
Provider Name (Legal Business Name): ALICIA HAGLUND MD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 LOMA VISTA RD
VENTURA CA
93003-1581
US

IV. Provider business mailing address

PO BOX 1206
GOLETA CA
93116-1206
US

V. Phone/Fax

Practice location:
  • Phone: 805-585-3086
  • Fax: 805-653-0161
Mailing address:
  • Phone: 805-964-3838
  • Fax: 805-683-3400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ALICIA HAGLUND
Title or Position: AUTHORIZED REPRESENTATIVE
Credential: MD
Phone: 310-626-7240