Healthcare Provider Details

I. General information

NPI: 1912295171
Provider Name (Legal Business Name): CLARISSA O LAGMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CLARISSA D OBISPO

II. Dates (important events)

Enumeration Date: 07/21/2011
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E DOMINGUEZ ST STE 110
CARSON CA
90746-3600
US

IV. Provider business mailing address

1000 E DOMINGUEZ ST STE 110
CARSON CA
90746-3615
US

V. Phone/Fax

Practice location:
  • Phone: 310-715-7755
  • Fax: 424-704-2493
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number21700
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: