Healthcare Provider Details

I. General information

NPI: 1689794398
Provider Name (Legal Business Name): MONICA PAZ GARIN-LAFLAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 11/05/2021
Certification Date: 11/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4348 ELECTRIC RD
ROANOKE VA
24018-0720
US

IV. Provider business mailing address

102 HIGHLAND AVE SE STE 305 CARILION CLINIC, PEDIATRIC GASTROENTEROLOGY
ROANOKE VA
24013-2253
US

V. Phone/Fax

Practice location:
  • Phone: 540-769-0976
  • Fax: 540-857-5389
Mailing address:
  • Phone: 540-985-9832
  • Fax: 540-224-4421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number35.089723
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number14453
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number0101254221
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: