Healthcare Provider Details

I. General information

NPI: 1518065788
Provider Name (Legal Business Name): RICHARD J. LAVACOT, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 05/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

477 N EL CAMINO REAL SUITE C-100
ENCINITAS CA
92024-1328
US

IV. Provider business mailing address

210 N TUSTIN AVE
SANTA ANA CA
92705-3807
US

V. Phone/Fax

Practice location:
  • Phone: 760-942-8800
  • Fax: 760-942-0106
Mailing address:
  • Phone: 800-883-7243
  • Fax: 714-647-1245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG39842
License Number StateCA

VIII. Authorized Official

Name: DR. RICHARD J LAVACOT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 800-883-7243