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Individual

DENISE MICHELLE LAGO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.A.

Contact information

Practice address
3030 CHILDRENS WAY, SUITE 402, SAN DIEGO, CA 92123-4232
(858) 309-7701
Mailing address
3860 CALLE FORTUNADA, SUITE 210, SAN DIEGO, CA 92123-4800
(858) 309-6303
(858) 309-6301

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA17574
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
PA17574
CA
Enumeration date
01/08/2007
Last updated
07/08/2007
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