Provider Demographics
NPI:1720042377
Name:LAL, SATISH K (MD)
Entity Type:Individual
Prefix:MR
First Name:SATISH
Middle Name:K
Last Name:LAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10841 WHITE OAK AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3811
Mailing Address - Country:US
Mailing Address - Phone:909-989-4002
Mailing Address - Fax:909-989-4004
Practice Address - Street 1:10841 WHITE OAK AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3811
Practice Address - Country:US
Practice Address - Phone:909-989-4002
Practice Address - Fax:909-989-4004
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34462207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA344620Medicaid
CAA344620Medicaid
CAA344621Medicare ID - Type Unspecified