Provider Demographics
NPI:1083774616
Name:LAU, STANLEY
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:
Last Name:LAU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1446 S SAN GABRIEL BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776
Mailing Address - Country:US
Mailing Address - Phone:626-307-9822
Mailing Address - Fax:626-307-9222
Practice Address - Street 1:1446 S SAN GABRIEL BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776
Practice Address - Country:US
Practice Address - Phone:626-307-9822
Practice Address - Fax:626-307-9222
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43148332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME03159FMedicaid
CADME03159FMedicaid