Provider Demographics
NPI:1417372350
Name:HELMHOUT, LACI (PA-C)
Entity Type:Individual
Prefix:
First Name:LACI
Middle Name:
Last Name:HELMHOUT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 LORING ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-1757
Mailing Address - Country:US
Mailing Address - Phone:503-545-8232
Mailing Address - Fax:
Practice Address - Street 1:4215 SPRING ST
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-7965
Practice Address - Country:US
Practice Address - Phone:619-461-7277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-02
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51447363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical