Provider Demographics
NPI:1700062916
Name:LAWRENCE S PAIKOFF, MD
Entity Type:Organization
Organization Name:LAWRENCE S PAIKOFF, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-750-3500
Mailing Address - Street 1:1756 PICASSO AVE
Mailing Address - Street 2:STE. #E
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-0549
Mailing Address - Country:US
Mailing Address - Phone:530-750-3500
Mailing Address - Fax:530-750-3045
Practice Address - Street 1:1756 PICASSO AVE
Practice Address - Street 2:STE. #E
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95618-0549
Practice Address - Country:US
Practice Address - Phone:530-750-3500
Practice Address - Fax:530-750-3045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG61673174400000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAYYY50116YMedicare PIN