Provider Information for 1225361710
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MAZDA LAKPOUR
Sex: Male
NPI: 1225361710
Last Updated: 2016-05-12
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1225361710 | ||||||||
| Enumeration Date | 2009-09-15 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 4211 AVALON BLVD LOS ANGELES, CA 90011-5622 United States Phone: 323-233-0425 | Fax:323-232-2366 | ||||||||
| Primary Practice Address | 3800 S FIGUEROA ST LOS ANGELES, CA 90037-1206 United States Phone: 323-233-0425 | Fax: | ||||||||
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