Provider Demographics
NPI:1952955486
Name:LE SHANGRI LA
Entity Type:Organization
Organization Name:LE SHANGRI LA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-664-0125
Mailing Address - Street 1:7600 E CAMELBACK RD STE 7
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-2106
Mailing Address - Country:US
Mailing Address - Phone:480-664-0125
Mailing Address - Fax:480-664-0219
Practice Address - Street 1:7545 E ANGUS DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6409
Practice Address - Country:US
Practice Address - Phone:480-664-0125
Practice Address - Fax:480-664-0219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical