Basic Information
| Provider Information | |||||||||
| NPI: | 1578528709 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAVETTER | ||||||||
| FirstName: | ALLAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20358 MILJEVICH DR | ||||||||
| Address2: | |||||||||
| City: | SARATOGA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950704349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4082842282 | ||||||||
| FaxNumber: | 4087540450 | ||||||||
| Practice Location | |||||||||
| Address1: | 20358 MILJEVICH DR | ||||||||
| Address2: | |||||||||
| City: | SARATOGA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950704349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4082842282 | ||||||||
| FaxNumber: | 4087540450 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2006 | ||||||||
| LastUpdateDate: | 12/14/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | G15571 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0208X | G15571 | CA | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Infectious Diseases |
ID Information
| ID | Type | State | Issuer | Description | 00G155710 | 05 | CA | MEDICAID |