Provider Demographics
NPI:1295979227
Name:LAGUE, DAVID AUGUSTINE (MPA-C)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:AUGUSTINE
Last Name:LAGUE
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Gender:M
Credentials:MPA-C
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Mailing Address - Street 1:363 MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-1729
Mailing Address - Country:US
Mailing Address - Phone:650-562-6466
Mailing Address - Fax:650-306-0250
Practice Address - Street 1:363 MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1729
Practice Address - Country:US
Practice Address - Phone:650-562-6466
Practice Address - Fax:650-306-0250
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2017-01-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPA16903363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical