Healthcare Provider Details

I. General information

NPI: 1023245230
Provider Name (Legal Business Name): DR. MICHAEL AARON LALEZARIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2009
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1082 GLENDON AVE
LOS ANGELES CA
90024-2908
US

IV. Provider business mailing address

127 N GARDNER ST
LOS ANGELES CA
90036-2719
US

V. Phone/Fax

Practice location:
  • Phone: 310-906-2270
  • Fax: 310-861-8824
Mailing address:
  • Phone: 310-301-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA109360
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberA109360
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: