Provider Demographics
NPI:1932473618
Name:GOTO, LAVINIA S (RN, DHA)
Entity Type:Individual
Prefix:DR
First Name:LAVINIA
Middle Name:S
Last Name:GOTO
Suffix:
Gender:F
Credentials:RN, DHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 CHERRY AVE NE
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-4924
Mailing Address - Country:US
Mailing Address - Phone:503-304-3408
Mailing Address - Fax:503-304-3434
Practice Address - Street 1:3410 CHERRY AVE NE
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-4924
Practice Address - Country:US
Practice Address - Phone:503-304-3408
Practice Address - Fax:503-304-3434
Is Sole Proprietor?:No
Enumeration Date:2012-02-28
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200340299RN163W00000X, 163WC0400X, 163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management