Provider Demographics
NPI:1013233188
Name:SINGH, LARRY
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:
Last Name:SINGH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81840 AVENUE 46
Mailing Address - Street 2:STE 201
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-3936
Mailing Address - Country:US
Mailing Address - Phone:760-393-5122
Mailing Address - Fax:760-238-5985
Practice Address - Street 1:45920 CIMARRON RD
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5098
Practice Address - Country:US
Practice Address - Phone:760-393-5122
Practice Address - Fax:760-238-5985
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-14
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator