Provider Demographics
NPI:1578005088
Name:MEDICAL SUPPORT LOS ANGELES A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:MEDICAL SUPPORT LOS ANGELES A MEDICAL CORPORATION
Other - Org Name:MSLA, A MEDICAL CORPORATION
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SAHNIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SICIARZ-LAMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-407-2152
Mailing Address - Street 1:1294 E COLORADO BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-1901
Mailing Address - Country:US
Mailing Address - Phone:626-407-2152
Mailing Address - Fax:626-239-3666
Practice Address - Street 1:2110 E FLAMINGO RD
Practice Address - Street 2:SUITE #216
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5190
Practice Address - Country:US
Practice Address - Phone:702-413-9098
Practice Address - Fax:702-413-1293
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL SUPPORT LOS ANGELES A MEDICAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical ExaminerGroup - Multi-Specialty