Healthcare Provider Details

I. General information

NPI: 1679731889
Provider Name (Legal Business Name): COURTNEY ANN LACAZE-ADAMS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY ANN LACAZE M.D.

II. Dates (important events)

Enumeration Date: 05/26/2008
Last Update Date: 12/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4341 GOLDEN CENTER DR SUITE A
PLACERVILLE CA
95667-6260
US

IV. Provider business mailing address

PO BOX 45680
SAN FRANCISCO CA
94145-0680
US

V. Phone/Fax

Practice location:
  • Phone: 530-626-1141
  • Fax:
Mailing address:
  • Phone: 530-626-1141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number#A105930
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: