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General NPI Number Information
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NPI Number | 1962081406
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Entity Type | Organization
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Legal Business Name | LAGOMCARE, A MEDICAL CORPORATION
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Dates
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Enumeration Date | 04/02/2021
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Last Update Date | 08/08/2021
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Provider Practice Location Address
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Address Line | 5830 OVERHILL DR STE 1
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City | LOS ANGELES
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State | CA
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Zip | 90043-2710
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Country | US
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Telephone | 310-887-1112
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 452513
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City | LOS ANGELES
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State | CA
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Zip | 90045-8534
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | JACQUELINE GRIER
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Credential | NP
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Telephone | 310-887-1112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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