Basic Information
| Provider Information | |||||||||
| NPI: | 1346620788 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LALLY | ||||||||
| FirstName: | RAJWANT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1143 MISSOURI ST | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945336007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074359911 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2211 SANTA MARIA DR | ||||||||
| Address2: | |||||||||
| City: | PITTSBURG | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945654353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9253603385 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2015 | ||||||||
| LastUpdateDate: | 06/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | CA | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 163WA0400X | 714080 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | Addiction (Substance Use Disorder) |
No ID Information.