Provider Demographics
NPI:1205144912
Name:L.S.OLAES,M.D. A MEDICAL CORPORATION
Entity type:Organization
Organization Name:L.S.OLAES,M.D. A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:LAMBERTO
Authorized Official - Middle Name:SALUD
Authorized Official - Last Name:OLAES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-664-7628
Mailing Address - Street 1:1267 N VIRGIL AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-2017
Mailing Address - Country:US
Mailing Address - Phone:323-664-7628
Mailing Address - Fax:323-664-7647
Practice Address - Street 1:1267 N VIRGIL AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-2017
Practice Address - Country:US
Practice Address - Phone:323-664-7628
Practice Address - Fax:323-664-7647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 39580261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A395800Medicaid
CA00A395800Medicaid
CAA39580Medicare PIN