Healthcare Provider Details

I. General information

NPI: 1356319651
Provider Name (Legal Business Name): RAILEEN C LAGOC M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 12/12/2019
Certification Date: 12/12/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 ROSALINE AVE
REDDING CA
96001-2534
US

IV. Provider business mailing address

1850 ROSALINE AVE
REDDING CA
96001-2534
US

V. Phone/Fax

Practice location:
  • Phone: 530-244-6534
  • Fax: 530-244-6595
Mailing address:
  • Phone: 530-244-6534
  • Fax: 530-241-5377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA72405
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: