Provider Demographics
NPI:1093081119
Name:ELSA T LAVADIA MD INC
Entity Type:Organization
Organization Name:ELSA T LAVADIA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-634-0955
Mailing Address - Street 1:2323 16TH STREET SUITE 108
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-3453
Mailing Address - Country:US
Mailing Address - Phone:661-631-1636
Mailing Address - Fax:661-631-1831
Practice Address - Street 1:2323 16TH STREET SUITE 108
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-3453
Practice Address - Country:US
Practice Address - Phone:661-631-1636
Practice Address - Fax:661-631-1831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-23
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72966208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty