Healthcare Provider Details

I. General information

NPI: 1962001024
Provider Name (Legal Business Name): LAGUNA HEALTHCARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2020
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 BASSWOOD RD
PARAJE NM
87007
US

IV. Provider business mailing address

PO BOX 1407
LAGUNA NM
87026-1407
US

V. Phone/Fax

Practice location:
  • Phone: 505-552-5664
  • Fax:
Mailing address:
  • Phone: 505-552-5664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CARRIE L SARNICKY
Title or Position: CEO
Credential:
Phone: 505-552-5664