Healthcare Provider Details

I. General information

NPI: 1457469157
Provider Name (Legal Business Name): ELSA T LAVADIA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 OLD RIVER RD STE 105
BAKERSFIELD CA
93311-9506
US

IV. Provider business mailing address

24422 AVENIDA DE LA CARLOTA STE 300
LAGUNA HILLS CA
92653-3628
US

V. Phone/Fax

Practice location:
  • Phone: 661-663-4700
  • Fax: 661-663-4740
Mailing address:
  • Phone: 949-599-2423
  • Fax: 661-663-4740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA72966
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: