Provider Demographics
NPI:1124297957
Name:LAANO, ALICIA ZABELLA (MD)
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:ZABELLA
Last Name:LAANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:ALICIA
Other - Middle Name:ZABELLA
Other - Last Name:LAANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2228 WEST 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057
Mailing Address - Country:US
Mailing Address - Phone:213-383-5773
Mailing Address - Fax:213-383-5783
Practice Address - Street 1:2228 WEST 7TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057
Practice Address - Country:US
Practice Address - Phone:213-383-5773
Practice Address - Fax:213-383-5783
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30080207Q00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A300800OtherMEDICAL PROVIDER
CAW6544AOtherMEDICARE ID
CA8814330OtherMEDICAL PIN
CAGR0078650Medicaid
CAW6544AMedicare Oscar/Certification
CAGR0078650Medicaid
CA00A300800OtherMEDICAL PROVIDER
CA8814330Medicare UPIN
CAA87368Medicare PIN