Provider Demographics
NPI:1396888095
Name:RAILEEN CARREON LAGOC, M.D., INC.
Entity type:Organization
Organization Name:RAILEEN CARREON LAGOC, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAILEEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:LAGOC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-244-6534
Mailing Address - Street 1:PO BOX 496084
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96049-6084
Mailing Address - Country:US
Mailing Address - Phone:530-241-0473
Mailing Address - Fax:
Practice Address - Street 1:1832 BUENAVENTURA BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-3828
Practice Address - Country:US
Practice Address - Phone:530-244-6534
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72405208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG45656Medicare UPIN