Provider Demographics
NPI:1952956237
Name:LAL, PRAVESH PRANEET
Entity Type:Individual
Prefix:
First Name:PRAVESH
Middle Name:PRANEET
Last Name:LAL
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 1:8320 DANDELION DR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-4557
Mailing Address - Country:US
Mailing Address - Phone:916-375-9140
Mailing Address - Fax:
Practice Address - Street 1:8320 DANDELION DR
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-4557
Practice Address - Country:US
Practice Address - Phone:916-375-9140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty