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General NPI Number Information
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NPI Number | 1679731889
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Entity Type | Individual
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Provider Name | COURTNEY ANN LACAZE-ADAMS M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/26/2008
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Last Update Date | 12/18/2013
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Provider Practice Location Address
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Address Line | 4341 GOLDEN CENTER DR SUITE A
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City | PLACERVILLE
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State | CA
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Zip | 95667-6260
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Country | US
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Telephone | 530-626-1141
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 45680
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City | SAN FRANCISCO
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State | CA
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Zip | 94145-0680
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Country | US
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Telephone | 530-626-1141
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Fax |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | #A105930
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License Number State | CA
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