Provider Demographics
NPI:1912295171
Name:LAGMAN, CLARISSA O (PA-C)
Entity type:Individual
Prefix:
First Name:CLARISSA
Middle Name:O
Last Name:LAGMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CLARISSA
Other - Middle Name:D
Other - Last Name:OBISPO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1000 E DOMINGUEZ ST STE 110
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-3615
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 E DOMINGUEZ ST
Practice Address - Street 2:STE 110
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-3600
Practice Address - Country:US
Practice Address - Phone:310-715-7755
Practice Address - Fax:424-704-2493
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21700363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical