MEDICARE: MS. STACY M LASATER P.A.

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	PA19564	CA

General Provider Information

NPI Number	:	1922276773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STACY M LASATER P.A.

Provider Business Mailing Address
First Line	:	5725 W LAS POSITAS BLVD
Second Line	:	STE 100
City	:	PLEASANTON
State	:	CA
Zip	:	94588-4007
Country	:	US
Telephone Number	:	530-671-2650
Fax Number	:	530-671-4265

Provider Business Practice Location Address
First Line	:	370 DEL NORTE AVE STE 201
Second Line	:
City	:	YUBA CITY
State	:	CA
Zip	:	95991-4142
Country	:	US
Telephone Number	:	530-671-2650
Fax Number	:	530-671-4265

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

Provider Enumeration Date	:	02/14/2008
Last Update Date	:	05/13/2016

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