Basic Information
Provider Information
NPI: 1205996501
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LALA
FirstName: VIMAL
MiddleName: S.
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7230 MEDICAL CENTER DR
Address2: SUITE 500
City: WEST HILLS
State: CA
PostalCode: 913071907
CountryCode: US
TelephoneNumber: 8183487246
FaxNumber: 8183487248
Practice Location
Address1: 7230 MEDICAL CENTER DR
Address2: SUITE 500
City: WEST HILLS
State: CA
PostalCode: 913071907
CountryCode: US
TelephoneNumber: 8183487246
FaxNumber: 8183487248
Other Information
ProviderEnumerationDate: 12/11/2006
LastUpdateDate: 05/18/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208VP0014X20A8461CAY Allopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
207L00000X20A 8461CAN Allopathic & Osteopathic PhysiciansAnesthesiology 
207LP2900X20A 8461CAN Allopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine

No ID Information.


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