Provider Demographics
NPI:1417207614
Name:WEST LA PHYSICAL MEDICINE INC.
Entity Type:Organization
Organization Name:WEST LA PHYSICAL MEDICINE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:HALEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-473-7130
Mailing Address - Street 1:11110 OHIO AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3388
Mailing Address - Country:US
Mailing Address - Phone:310-473-7130
Mailing Address - Fax:310-473-5077
Practice Address - Street 1:11110 OHIO AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-3388
Practice Address - Country:US
Practice Address - Phone:310-473-7130
Practice Address - Fax:310-473-5077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-14
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89000208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH6316AMedicare PIN