Provider Demographics
NPI:1912709858
Name:LAGMAN, MELISSA MIRANDA (MS - SLP)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:MIRANDA
Last Name:LAGMAN
Suffix:
Gender:
Credentials:MS - SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2258 ALICANTE CV
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-4415
Mailing Address - Country:US
Mailing Address - Phone:619-289-3465
Mailing Address - Fax:
Practice Address - Street 1:690 OTAY LAKES RD STE 110
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-8904
Practice Address - Country:US
Practice Address - Phone:619-475-6910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20263235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist