Individual
ROBERT M LAVIGNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
1350 COLUMBIA ST UNIT 800, SAN DIEGO, CA 92101-3456
(619) 251-1652
(619) 324-7761
Mailing address
1350 COLUMBIA ST UNIT 800, SAN DIEGO, CA 92101-3456
(619) 251-1652
(619) 324-7761
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA21564
CA
363AM0700X
Medical Physician Assistant
Primary
PA21564
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA21564
STATE LICENSE
CA
Enumeration date
07/19/2011
Last updated
05/14/2020
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