Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | A102897 | CA |
Y | 2080P0203X | Pediatric Critical Care Doctor | P3189 | TX |
NPI | 1104073550 |
---|---|
Provider Name | Preston Lavinghousez |
First Address | Austin, TX 78723-3079 |
Second Address | Austin, TX 78723-3079 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2008 |
Last Update Date | 05/06/2012 |