Provider Demographics
NPI:1396287025
Name:MEDICAL SUPPORT LOS ANGELES, A MEDICAL CORPORATION
Entity type:Organization
Organization Name:MEDICAL SUPPORT LOS ANGELES, A MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
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:626-440-7064
Practice Address - Street 1:99-128 AIEA HEIGHTS DR
Practice Address - Street 2:SUITE # 405
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-3925
Practice Address - Country:US
Practice Address - Phone:808-488-0880
Practice Address - Fax:808-488-0881
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL SUPPORT LOS ANGELES, A MEDICAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-11
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical ExaminerGroup - Multi-Specialty