Provider Demographics
NPI:1114947611
Name:LASCANO, MIGUEL L (MD)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:L
Last Name:LASCANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 27TH ST
Mailing Address - Street 2:SUITE 405
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-2055
Mailing Address - Country:US
Mailing Address - Phone:661-322-4902
Mailing Address - Fax:661-322-4904
Practice Address - Street 1:1524 27TH ST
Practice Address - Street 2:SUITE 405
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-2055
Practice Address - Country:US
Practice Address - Phone:661-322-4902
Practice Address - Fax:661-322-4904
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50264207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A502640Medicaid
CA00A502640Medicaid
CAF77417Medicare UPIN