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
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | 20A8461 | CA | Y |   | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 207L00000X | 20A 8461 | CA | N |   | Allopathic & Osteopathic Physicians | Anesthesiology |   | 207LP2900X | 20A 8461 | CA | N |   | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.