Provider Demographics
NPI:1679150759
Name:LASEK, JAMES CLARK (C PED)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:CLARK
Last Name:LASEK
Suffix:
Gender:M
Credentials:C PED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4781 E GETTYSBURG AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-1814
Mailing Address - Country:US
Mailing Address - Phone:559-270-4746
Mailing Address - Fax:
Practice Address - Street 1:4781 E GETTYSBURG AVE STE 104
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-1814
Practice Address - Country:US
Practice Address - Phone:559-270-4746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3987224L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist