Provider Demographics
NPI:1023245230
Name:LALEZARIAN, MICHAEL AARON
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:AARON
Last Name:LALEZARIAN
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 1:127 N GARDNER ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-2719
Mailing Address - Country:US
Mailing Address - Phone:310-301-6800
Mailing Address - Fax:
Practice Address - Street 1:1082 GLENDON AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-2908
Practice Address - Country:US
Practice Address - Phone:310-906-2270
Practice Address - Fax:310-861-8824
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1093602085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ59332OtherLICENSE
CA0A1093600Medicaid
CAA109360OtherLICENSE