Provider Demographics
NPI:1043274095
Name:LAGUNA MEDICAL INC
Entity type:Organization
Organization Name:LAGUNA MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:SIEGFRIED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-321-4967
Mailing Address - Street 1:325 E SOUTHERN AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-5208
Mailing Address - Country:US
Mailing Address - Phone:480-894-0360
Mailing Address - Fax:480-894-0361
Practice Address - Street 1:325 E SOUTHERN AVE
Practice Address - Street 2:STE 104
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-5208
Practice Address - Country:US
Practice Address - Phone:480-894-0360
Practice Address - Fax:480-894-0361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ4637340001Medicare PIN
AZ4637340001Medicare NSC