Healthcare Provider Details

I. General information

NPI: 1578742318
Provider Name (Legal Business Name): LAWRENCE S MIHALAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11645 WILSHIRE BLVD 988
LOS ANGELES CA
90025-1708
US

IV. Provider business mailing address

11645 WILSHIRE BLVD SUITE. 988
LOS ANGELES CA
90025-1708
US

V. Phone/Fax

Practice location:
  • Phone: 310-820-1561
  • Fax: 310-826-0895
Mailing address:
  • Phone: 310-820-1561
  • Fax: 310-826-0895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberG29836
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: