Provider Demographics
NPI:1043773179
Name:LA LAKERS
Entity Type:Organization
Organization Name:LA LAKERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT NBA
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-426-6000
Mailing Address - Street 1:2275 E MARIPOSA AVE
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-5029
Mailing Address - Country:US
Mailing Address - Phone:310-426-6000
Mailing Address - Fax:
Practice Address - Street 1:2275 E MARIPOSA AVE
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-5029
Practice Address - Country:US
Practice Address - Phone:310-426-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-06
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20-614414OtherTHERAPEUTIC IMPAIRED PROFESSIONAL PROVIDER