Basic Information
| Provider Information | |||||||||
| NPI: | 1396888095 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RAILEEN CARREON LAGOC, M.D., INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 496084 | ||||||||
| Address2: | |||||||||
| City: | REDDING | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960496084 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302410473 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1832 BUENAVENTURA BLVD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | REDDING | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960013828 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302446534 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2007 | ||||||||
| LastUpdateDate: | 06/17/2009 | ||||||||
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| AuthorizedOfficialLastName: | LAGOC | ||||||||
| AuthorizedOfficialFirstName: | RAILEEN | ||||||||
| AuthorizedOfficialMiddleName: | C. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5302446534 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | A72405 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.