Basic Information
| Provider Information | |||||||||
| NPI: | 1295035426 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FERNANDO | ||||||||
| FirstName: | LALIN | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21732 S VERMONT AVE STE 210 | ||||||||
| Address2: | |||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905022180 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3107813400 | ||||||||
| FaxNumber: | 3103287217 | ||||||||
| Practice Location | |||||||||
| Address1: | 21732 S VERMONT AVE STE 210 | ||||||||
| Address2: | |||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905022180 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3107813400 | ||||||||
| FaxNumber: | 3107820754 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2010 | ||||||||
| LastUpdateDate: | 03/05/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | 600275 | CA | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
No ID Information.