Provider Demographics
NPI:1720415011
Name:REDDING PEDIATRICS, INC
Entity type:Organization
Organization Name:REDDING PEDIATRICS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RAILEEN
Authorized Official - Middle Name:CARREON
Authorized Official - Last Name:LAGOC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-244-6534
Mailing Address - Street 1:1850 ROSALINE AVE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2534
Mailing Address - Country:US
Mailing Address - Phone:530-244-6534
Mailing Address - Fax:530-244-6595
Practice Address - Street 1:1850 ROSALINE AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2534
Practice Address - Country:US
Practice Address - Phone:530-244-6534
Practice Address - Fax:530-244-6595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-01
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72405261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care