LEIANA LUTZ JAGOLINO


Address: 2925 Ryan Dr Se, Salem, OR 97301-9687
Phone: 5033991262

LEIANA LUTZ JAGOLINO (NPI# 1538459599) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1538459599
Entity Type Individual
Full Name LEIANA LUTZ JAGOLINO
Credential PA
Practice Address 2925 Ryan Dr Se
Salem
OR 97301-9687
Practice Telephone 5033991262
Practice Fax Number 5033710777
Mailing Telephone (503) 399-1262
Mailing Fax Number 5033710777
Enumeration Date 2011-04-12
Last Update Date 2018-03-17
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 363A00000X Physician Assistant 006077 GA Physician Assistants & Advanced Practice Nursing Providers
Y 363AM0700X Physician Assistant
Specialization: Medical
PA167677 OR Physician Assistants & Advanced Practice Nursing Providers

Other Provider Identifier

State Issuer Identifier Type Code
GA 003109002A 05
WA 2044027 05
OR 500685132 05

Provider Secondary Practice Location

Address Telephone Number Fax Number
19250 Sw 90th Ave, Tualatin, OR 970627585 5036923750 5036912324

Office Location

Street Address 2925 RYAN DR SE
City SALEM
State OR
Zip Code 97301-9687

Providers in the same location

NPI Name Taxonomy Address Enumeration
1417908757 Jose Novoa Radiology 2925 Ryan Dr Se, Salem, OR 97301-9687 2006-05-12
1083255541 Kristi Souza Physician Assistant 2925 Ryan Dr Se, Salem, OR 97301-9687 2019-10-04
1306494638 Hazel Milano Physician Assistant 2925 Ryan Dr Se, Salem, OR 97301-9687 2019-08-29
1255804233 Shannon Jean Palmer Physician Assistant 2925 Ryan Dr Se, Salem, OR 97301-9687 2019-01-02
1326454885 Jessica M Hoyle Radiology 2925 Ryan Dr Se, Salem, OR 97301-9687 2014-07-05
1104236371 Lauren A Hodgson Physician Assistant 2925 Ryan Dr Se, Salem, OR 97301-9687 2014-04-28
1053721258 Jason Cody Hedge Radiology 2925 Ryan Dr Se, Salem, OR 97301-9687 2014-04-28
1174940126 David Prosser Radiology 2925 Ryan Dr Se, Salem, OR 97301-9687 2014-03-27
1659639557 Ryan Moore Radiology 2925 Ryan Dr Se, Salem, OR 97301 2012-04-27
1710252036 Tyler Robert Moore Radiology 2925 Ryan Dr Se, Salem, OR 97301 2012-03-20
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1205450970 Jehan Seals Behavior Technician 3400 State St Set G750, Salem, OR 97301 2020-05-29
1093335929 Sterling Recovery, LLC Dietitian, Registered 3758 Amber St Ne #105, Salem, OR 97301 2020-04-21
1760018360 Riverfront Mental Health LLC Counselor 338 State St, Suite 985, Salem, OR 97301 2020-03-16
1871126888 Amity Beth Haddon Maxwell Social Worker Oregon State Hospital, 2600 Center St Ne, Salem, OR 97301 2020-02-18
1861042632 Brenda Grizelda Vargas Behavioral Analyst 3400 State Ste Ste G750, Salem, OR 97301 2019-09-13
1588213177 Natalie Stone Registered Nurse 2045 Siverton Rd Ne, Salem, OR 97301 2019-09-06
1588228720 Jeramy Disenso Counselor 270 Cottage St Ne, Salem, OR 97301 2019-04-23
1801353297 Gwendolyn Kersey Registered Nurse 2600 Center St Ne Oregon State Hospital, Salem, OR 97301 2019-02-21
1841769114 Spine Clinic PC Massage Therapist 1281 Lancaster Drive Ne, Salem, OR 97301 2018-11-16
1013482132 Kellie Linn Hansen Physical Therapist 4049 Market St Se, Salem, OR 97301 2018-10-04
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Taxonomy Information

Taxonomy Code 363AM0700X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Physician Assistant
Specialization Medical

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1285255851 Darby Samantha Jalbert Physician Assistant 2480 Liberty St Ne Ste 110, Salem, OR 97301-8381 2020-05-05
1639614852 Gregory Bull Physician Assistant 622 Fernwood Dr, Salem, VA 24153-2654 2016-12-24
1841648862 Theron J Wiese Physician Assistant 1395 Commercial St Se, Salem, OR 97302-4205 2016-05-31
1922329697 Charleen Ann Thorburn Physician Assistant 22 Keewaydin Dr, Salem, NH 03079-2839 2010-06-17
1316188006 Judith A Mitchell Physician Assistant 4999 Skyline Rd. S., Salem, OR 97306 2009-03-10
1215912712 Amy Gouley Physician Assistant 1793 13th St Se, Salem, OR 97302-2541 2005-12-07
1306827100 William Earle Williams Physician Assistant 1233 Edgewater St Nw, Salem, OR 97304-4049 2005-11-08
1700485224 Roderick Mao Physician Assistant 159 N Broadway, Salem, NH 03079-2136 2020-10-26
1447719752 Christine Nicole Jeffries Physician Assistant 360 Church St Se, Salem, OR 97301-3796 2019-03-16
1265999338 Brolin Johnson Physician Assistant 1793 13th St Se, Salem, OR 97302-2541 2019-02-26
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Competitor

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City SALEM
Zip Code 97301

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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