Provider Demographics
NPI:1598256182
Name:LALL, NEIL MOHAN (HCAC)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:MOHAN
Last Name:LALL
Suffix:
Gender:M
Credentials:HCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23406 97TH PL W
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-5621
Mailing Address - Country:US
Mailing Address - Phone:206-533-9846
Mailing Address - Fax:
Practice Address - Street 1:23406 97TH PL W
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-5621
Practice Address - Country:US
Practice Address - Phone:206-533-9846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-20
Last Update Date:2018-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
753425374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA753425Medicaid