Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | G15571 | CA |
N | 2080P0208X | Pediatric Infectious Diseases | G15571 | CA |
NPI | 1578528709 |
---|---|
Provider Name | Allan Lavetter |
First Address | Saratoga, CA 95070-4349 |
Second Address | Saratoga, CA 95070-4349 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2006 |
Last Update Date | 14/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G155710 | (05) | CA |
A39568 | (02) | CA |