Provider Demographics
NPI:1619311222
Name:LAL, MITESH GOPAL (MD)
Entity Type:Individual
Prefix:DR
First Name:MITESH
Middle Name:GOPAL
Last Name:LAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1441 FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4404
Mailing Address - Country:US
Mailing Address - Phone:209-576-3523
Mailing Address - Fax:209-576-3597
Practice Address - Street 1:825 DELBON AVE
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2016
Practice Address - Country:US
Practice Address - Phone:209-576-3525
Practice Address - Fax:209-576-3544
Is Sole Proprietor?:No
Enumeration Date:2013-04-25
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA138579207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine