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NPI Code Detail

MEDICARE: CHRISTINA LYNN LASICH M.D.

MEDICARE: CHRISTINA LYNN LASICH M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12081P2900XPain Medicine (Physical Medicine & Rehabilitation) PhysicianA68111CA

General Provider Information

NPI Number : 1679557862
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTINA LYNN LASICH M.D.
Provider Business Mailing Address
First Line : 13184 ALLISON RANCH RD
Second Line :
City : GRASS VALLEY
State : CA
Zip : 95949-9607
Country : US
Telephone Number : 530-273-8480
Fax Number :
Provider Business Practice Location Address
First Line : 333 LAWS AVE
Second Line :
City : UKIAH
State : CA
Zip : 95482-6540
Country : US
Telephone Number : 707-468-1010
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2005
Last Update Date : 05/16/2021

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