Provider Demographics
NPI:1063896942
Name:LAKEWOOD IPA, INC
Entity type:Organization
Organization Name:LAKEWOOD IPA, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VARSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-602-1563
Mailing Address - Street 1:4909 LAKEWOOD BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-2405
Mailing Address - Country:US
Mailing Address - Phone:562-602-1563
Mailing Address - Fax:562-529-8490
Practice Address - Street 1:4909 LAKEWOOD BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-2405
Practice Address - Country:US
Practice Address - Phone:562-602-1563
Practice Address - Fax:562-529-8490
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAKEWOOD IPA, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization