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NPI Code Detail

MEDICARE: MS. LISA DEFRANCO GAVIN MD, MPH

MEDICARE: MS. LISA DEFRANCO GAVIN MD, MPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207ZF0201XForensic Pathology Physician13249NV
2207ZF0201XForensic Pathology PhysicianMD2008-0361NM

General Provider Information

NPI Number : 1295909406
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LISA DEFRANCO GAVIN MD, MPH
Provider Business Mailing Address
First Line : 1704 PINTO LN
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-4102
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1704 PINTO LN
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-4102
Country : US
Telephone Number : 702-455-3210
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2008
Last Update Date : 12/28/2010

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