Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | G29836 | CA |
NPI | 1578742318 |
---|---|
Provider Name | Dr. Lawrence S Mihalas |
First Address | Los Angeles, CA 90025-1708 |
Second Address | Los Angeles, CA 90025-1708 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2007 |
Last Update Date | 10/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A91234 | (02) | CA |
AM6572576 | DEA NUMBER (01) | CA |
G29836 | STATE LICENSE NUMBER (01) | CA |