Provider Demographics
NPI:1093781197
Name:LOLACHI, ANOOSHEH (MD)
Entity Type:Individual
Prefix:DR
First Name:ANOOSHEH
Middle Name:
Last Name:LOLACHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANOOSHEH
Other - Middle Name:
Other - Last Name:POURDANESH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3604
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES PENINSULA
Mailing Address - State:CA
Mailing Address - Zip Code:90274-9511
Mailing Address - Country:US
Mailing Address - Phone:310-544-0442
Mailing Address - Fax:
Practice Address - Street 1:15901 HAWTHORNE BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-2655
Practice Address - Country:US
Practice Address - Phone:310-371-9900
Practice Address - Fax:310-371-1800
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51135207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3015080Medicaid
MI06308357111Medicare ID - Type Unspecified