Provider Demographics
NPI:1215918727
Name:LAL, PRATIBHA BOBBY (MD)
Entity type:Individual
Prefix:DR
First Name:PRATIBHA
Middle Name:BOBBY
Last Name:LAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1930 VILLAGE CENTER CIR
Mailing Address - Street 2:#3-604
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-6299
Mailing Address - Country:US
Mailing Address - Phone:949-509-4423
Mailing Address - Fax:
Practice Address - Street 1:5701 W CHARLESTON BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-1217
Practice Address - Country:US
Practice Address - Phone:702-750-0313
Practice Address - Fax:702-487-3197
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM1863208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35082545OtherMEDICAL LICENSE NUMBER
NV12473OtherMEDICAL LICENSE