Provider Demographics
NPI:1639506314
Name:SUNDEEP LAL PA
Entity Type:Organization
Organization Name:SUNDEEP LAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUNDEEP
Authorized Official - Middle Name:S
Authorized Official - Last Name:LAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-550-8282
Mailing Address - Street 1:601 E SAN ANTONIO ST
Mailing Address - Street 2:STE 304W
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-6004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601 E SAN ANTONIO ST
Practice Address - Street 2:STE 304W
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-6004
Practice Address - Country:US
Practice Address - Phone:361-574-8878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-26
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN9382208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty