Provider Demographics
NPI:1750779567
Name:MORMINO, LAVONNE MARCELL (CADC/CAS/RAS/CSC)
Entity type:Individual
Prefix:MRS
First Name:LAVONNE
Middle Name:MARCELL
Last Name:MORMINO
Suffix:
Gender:F
Credentials:CADC/CAS/RAS/CSC
Other - Prefix:MRS
Other - First Name:LAVONNE
Other - Middle Name:MARCELL
Other - Last Name:BARTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CADC/CAS/RAS/CSC
Mailing Address - Street 1:993 POSTAL WAY
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-6945
Mailing Address - Country:US
Mailing Address - Phone:760-630-9922
Mailing Address - Fax:760-630-9996
Practice Address - Street 1:993 POSTAL WAY
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6945
Practice Address - Country:US
Practice Address - Phone:760-630-9922
Practice Address - Fax:760-630-9996
Is Sole Proprietor?:No
Enumeration Date:2014-12-31
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA3589274OtherCALIFORNIA DRIVER LICENSE