Provider Demographics
NPI:1598807372
Name:MEDICAL SUPPORT LOS ANGELES A MEDICAL CORP
Entity Type:Organization
Organization Name:MEDICAL SUPPORT LOS ANGELES A MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAHNIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SICIARZ LAMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-440-7001
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
Mailing Address - Country:US
Mailing Address - Phone:626-440-7001
Mailing Address - Fax:626-440-7003
Practice Address - Street 1:1060 EAST GREEN STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106
Practice Address - Country:US
Practice Address - Phone:626-440-7001
Practice Address - Fax:626-440-7003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty