Provider Demographics
NPI:1356319651
Name:LAGOC, RAILEEN C (MD)
Entity Type:Individual
Prefix:
First Name:RAILEEN
Middle Name:C
Last Name:LAGOC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 ROSALINE AVE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2534
Mailing Address - Country:US
Mailing Address - Phone:530-244-6534
Mailing Address - Fax:530-241-5377
Practice Address - Street 1:1850 ROSALINE AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2534
Practice Address - Country:US
Practice Address - Phone:530-244-6534
Practice Address - Fax:530-244-6595
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72405208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A724050Medicaid
CA00A724050Medicaid
CAG45656Medicare UPIN