MEDICARE: LARA TOGOAN PA-C

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
1	363A00000X	Physician Assistant	PA.PA.61411731	WA

General Provider Information

NPI Number	:	1598116584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARA TOGOAN PA-C

Provider Business Mailing Address
First Line	:	2020 UNITY ST
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98225
Country	:	US
Telephone Number	:	360-676-6177
Fax Number	:	360-671-3574

Provider Business Practice Location Address
First Line	:	2020 UNITY ST
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98225
Country	:	US
Telephone Number	:	360-676-6177
Fax Number	:	360-671-3574

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2016
Last Update Date	:	08/09/2023

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