Healthcare Provider Details

I. General information

NPI: 1447873070
Provider Name (Legal Business Name): LAILA BROWN-AIJALA OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2020
Last Update Date: 05/13/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82227 US HIGHWAY 111
INDIO CA
92201-5667
US

IV. Provider business mailing address

1700 S ARABY DR APT 92
PALM SPRINGS CA
92264-6857
US

V. Phone/Fax

Practice location:
  • Phone: 760-347-6636
  • Fax:
Mailing address:
  • Phone: 319-321-9898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.0003585
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number34808
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: