Individual
ERIC DAVID LAVIADDIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
20201 SHERMAN WAY STE 109, CANOGA PARK, CA 91306-3269
(818) 960-4000
(818) 922-7019
Mailing address
20201 SHERMAN WAY STE 109, CANOGA PARK, CA 91306-3269
(818) 960-4000
(818) 922-7019
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA20713
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051104
MEDICARE FQHC
CA
01
—
051105
MEDICARE FQHC
CA
05
—
1083624423
—
CA
Enumeration date
08/19/2010
Last updated
02/28/2025
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