Provider Demographics
NPI:1588858708
Name:LASSAGA, KIMBERLY ROCHELLE (ABOC)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ROCHELLE
Last Name:LASSAGA
Suffix:
Gender:F
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 CLARK AVE
Mailing Address - Street 2:SUITE N
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-5363
Mailing Address - Country:US
Mailing Address - Phone:530-671-1010
Mailing Address - Fax:530-671-7800
Practice Address - Street 1:229 CLARK AVE
Practice Address - Street 2:SUITE N
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-5363
Practice Address - Country:US
Practice Address - Phone:530-671-1010
Practice Address - Fax:530-671-7800
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD7247156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician