Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | K1518 | TX |
N | 208D00000X | General Practice Physician | K1518 | TX |
NPI | 1003813122 |
---|---|
Provider Name | Dr. Edanili Sagun Lacar |
First Address | Sammamish, WA 98075-7921 |
Second Address | Sammamish, WA 98075-7921 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2005 |
Last Update Date | 09/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
124992206;124992205 | (05) | TX |
124992207 | (05) | TX |
BL5082259 | DEA (01) | TX |
G35356 | (02) | |
K0099021 | DPS (01) | TX |
K1518 | MEDICAL LICENSE (01) | TX |