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General NPI Number Information
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NPI Number | 1467814475
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Entity Type | Individual
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Provider Name | LAVINA JETHANI M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/28/2016
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 401 15TH AVE SE
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City | PUYALLUP
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State | WA
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Zip | 98372-3715
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Country | US
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Telephone | 253-697-3265
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Fax | 931-208-3645
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Provider Business Mailing Address
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Address Line | 39 COUNTRY VIEW DR
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City | FREEHOLD
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State | NJ
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Zip | 07728-9019
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Country | US
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Telephone | 732-625-0072
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Fax | 931-208-3645
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P0004X
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Taxonomy Name | Spinal Cord Injury Medicine Physician
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License Number | MD61281055
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | BP10069716
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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