Provider Demographics
NPI:1609854397
Name:LACOUNT, ANISSA Y (MD)
Entity type:Individual
Prefix:
First Name:ANISSA
Middle Name:Y
Last Name:LACOUNT
Suffix:
Gender:F
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:9985 SIERRA AVE
Mailing Address - Street 2:PERMANENTE HUMAN RESOURCES
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-6720
Mailing Address - Country:US
Mailing Address - Phone:909-427-7132
Mailing Address - Fax:909-427-5033
Practice Address - Street 1:9985 SIERRA AVE
Practice Address - Street 2:KAISER PERMANENTE HUMAN RESOURCES
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-6720
Practice Address - Country:US
Practice Address - Phone:909-382-7100
Practice Address - Fax:909-382-7136
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2021-12-03
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Provider Licenses
StateLicense IDTaxonomies
CAA78550207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF142463OtherINLAND EMPIRE HEALTH PLAN
CAL082463OtherINLAND EMPIRE HEALTH PLAN
CA00A78550OtherEXPANDED ACCESS TO PRIMAR
CAMOLINAOtherMOLINA HEALTH CARE
CA00A87550Medicaid
CA00A78550Medicare ID - Type Unspecified