Provider Demographics
NPI:1225477706
Name:LRA MEDICAL
Entity Type:Organization
Organization Name:LRA MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIMMERING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-760-9622
Mailing Address - Street 1:21781 VENTURA BLVD
Mailing Address - Street 2:# 416
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1835
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21781 VENTURA BLVD
Practice Address - Street 2:# 416
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1835
Practice Address - Country:US
Practice Address - Phone:818-760-9622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies