Provider Demographics
NPI:1972027027
Name:MEDICAL SUPPORT LOS ANGELES A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:MEDICAL SUPPORT LOS ANGELES A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SAHNIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SICIARZ-LAMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-270-0292
Mailing Address - Street 1:1294 E COLORADO BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-1901
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1414 S MILLER ST
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-6923
Practice Address - Country:US
Practice Address - Phone:866-467-5222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL SUPPORT LOS ANGELES A MEDICAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-31
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical ExaminerGroup - Multi-Specialty