Provider Demographics
NPI:1194914689
Name:PARK LANE GLOBAL INC.
Entity type:Organization
Organization Name:PARK LANE GLOBAL INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:AVESTA
Authorized Official - Middle Name:
Authorized Official - Last Name:RASOULI
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:310-466-3738
Mailing Address - Street 1:292 S LA CIENEGA BLVD
Mailing Address - Street 2:102
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3330
Mailing Address - Country:US
Mailing Address - Phone:310-466-3738
Mailing Address - Fax:310-967-0121
Practice Address - Street 1:10573 W PICO BLVD
Practice Address - Street 2:221
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-2333
Practice Address - Country:US
Practice Address - Phone:310-466-3738
Practice Address - Fax:310-967-0121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48181332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies