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General NPI Number Information
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NPI Number | 1396888095
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Entity Type | Organization
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Legal Business Name | RAILEEN CARREON LAGOC, M.D., INC.
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 06/17/2009
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Provider Practice Location Address
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Address Line | 1832 BUENAVENTURA BLVD SUITE B
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City | REDDING
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State | CA
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Zip | 96001-3828
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Country | US
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Telephone | 530-244-6534
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 496084
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City | REDDING
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State | CA
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Zip | 96049-6084
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Country | US
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Telephone | 530-241-0473
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RAILEEN C. LAGOC
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Credential | M.D.
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Telephone | 530-244-6534
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A72405
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License Number State | CA
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