Provider Demographics
NPI:1205137452
Name:BAHMAN LALEZARI,M.D.INC
Entity type:Organization
Organization Name:BAHMAN LALEZARI,M.D.INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BAHMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LALEZARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-939-5346
Mailing Address - Street 1:4944 W PICO BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-4228
Mailing Address - Country:US
Mailing Address - Phone:323-939-5346
Mailing Address - Fax:323-939-5217
Practice Address - Street 1:4944 W PICO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-4228
Practice Address - Country:US
Practice Address - Phone:323-939-5346
Practice Address - Fax:323-939-5217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F81894Medicare UPIN