Provider Demographics
NPI:1043410236
Name:LORNE S LABEL M D A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:LORNE S LABEL M D A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LORNE
Authorized Official - Middle Name:S
Authorized Official - Last Name:LABEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-497-4500
Mailing Address - Street 1:2100 LYNN RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360
Mailing Address - Country:US
Mailing Address - Phone:805-497-4500
Mailing Address - Fax:805-495-1717
Practice Address - Street 1:2100 LYNN RD
Practice Address - Street 2:SUITE 230
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360
Practice Address - Country:US
Practice Address - Phone:805-497-4500
Practice Address - Fax:805-495-1717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG476232084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A92738Medicare UPIN
CAG47623Medicare PIN