Provider Demographics
NPI:1063954568
Name:MEDICAL SUPPORT LOS ANGELES A MEDICAL COR
Entity type:Organization
Organization Name:MEDICAL SUPPORT LOS ANGELES A MEDICAL COR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SAHNIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SICIARZ-LAMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-407-2152
Mailing Address - Street 1:1294 E COLORADO BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-1901
Mailing Address - Country:US
Mailing Address - Phone:626-407-2152
Mailing Address - Fax:626-239-3666
Practice Address - Street 1:564 RIO LINDO AVE
Practice Address - Street 2:SUITE #101
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1852
Practice Address - Country:US
Practice Address - Phone:530-566-9263
Practice Address - Fax:530-566-9265
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL SUPPORT LOS ANGELES A MEDICAL COR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical ExaminerGroup - Multi-Specialty