Provider Demographics
NPI:1013944313
Name:MLSL, INCORPORATED
Entity Type:Organization
Organization Name:MLSL, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA LUCILA
Authorized Official - Middle Name:SISON
Authorized Official - Last Name:LLANES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-813-1222
Mailing Address - Street 1:933 S SUNSET AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3410
Mailing Address - Country:US
Mailing Address - Phone:626-813-1222
Mailing Address - Fax:626-813-1221
Practice Address - Street 1:933 S SUNSET AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3410
Practice Address - Country:US
Practice Address - Phone:626-813-1222
Practice Address - Fax:626-813-1221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA800902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A800900Medicaid
CAW19845Medicare PIN