Provider Demographics
NPI:1962560250
Name:HITES, LASZLO (MD)
Entity type:Individual
Prefix:
First Name:LASZLO
Middle Name:
Last Name:HITES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6127 HARWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1339
Mailing Address - Country:US
Mailing Address - Phone:510-985-7348
Mailing Address - Fax:510-985-7367
Practice Address - Street 1:6127 HARWOOD AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1339
Practice Address - Country:US
Practice Address - Phone:510-985-7348
Practice Address - Fax:510-985-7367
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A371120207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A371120Medicaid
CA00A371120Medicare ID - Type Unspecified
CA00A371120Medicaid