Provider Demographics
NPI:1225129893
Name:LOURIE, LALEH (MD)
Entity Type:Individual
Prefix:
First Name:LALEH
Middle Name:
Last Name:LOURIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPT LA 21607
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91185-1607
Mailing Address - Country:US
Mailing Address - Phone:949-263-8620
Mailing Address - Fax:949-263-1639
Practice Address - Street 1:47-111 MONROE STREET
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92204-6739
Practice Address - Country:US
Practice Address - Phone:760-775-8458
Practice Address - Fax:760-775-2577
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA489012085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A489010Medicaid
CA00A489010OtherBS
CA00A489010Medicaid
CAG58218Medicare UPIN
CA00A489010Medicare PIN