Provider Demographics
NPI:1801920087
Name:LYNWOOD UNITED MEDICAL
Entity type:Organization
Organization Name:LYNWOOD UNITED MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:DA SARLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-357-0914
Mailing Address - Street 1:3150 E IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-3223
Mailing Address - Country:US
Mailing Address - Phone:626-357-0914
Mailing Address - Fax:626-357-0915
Practice Address - Street 1:3150 E IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-3223
Practice Address - Country:US
Practice Address - Phone:626-357-0914
Practice Address - Fax:626-357-0915
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LYNWOOD UNITED MEDICAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-16
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A369910207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A369910Medicaid
CA00A369910Medicaid