Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0401X | Internist - Addiction Medicine | A25942 | CA |
Y | 207RG0100X | Gastroenterologist | A25942 | CA |
NPI | 1053414607 |
---|---|
Provider Name | Mr. Dheeraj Lal |
First Address | Monrovia, CA 91016-4066 |
Second Address | Duarte, CA 91010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2006 |
Last Update Date | 13/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A24643 | (02) | |
OOA259420 | (05) | CA |