Provider Demographics
NPI:1942256920
Name:LAKEWOOD IPA
Entity Type:Organization
Organization Name:LAKEWOOD IPA
Other - Org Name:ALAMITOS IPA, ST. MARY IPA, BROOKSHIRE IPA
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:NEER
Authorized Official - Suffix:
Authorized Official - Credentials:MD, JD
Authorized Official - Phone:562-602-1563
Mailing Address - Street 1:4909 LAKEWOOD BLVD
Mailing Address - Street 2:STE. 200
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-2405
Mailing Address - Country:US
Mailing Address - Phone:562-602-1563
Mailing Address - Fax:562-529-8490
Practice Address - Street 1:4909 LAKEWOOD BLVD
Practice Address - Street 2:STE. 200
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-2405
Practice Address - Country:US
Practice Address - Phone:562-602-1563
Practice Address - Fax:562-529-8490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA011549302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization