Healthcare Provider Details

I. General information

NPI: 1205996501
Provider Name (Legal Business Name): VIMAL S. LALA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 05/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7230 MEDICAL CENTER DR SUITE 500
WEST HILLS CA
91307-1907
US

IV. Provider business mailing address

7230 MEDICAL CENTER DR SUITE 500
WEST HILLS CA
91307-1907
US

V. Phone/Fax

Practice location:
  • Phone: 818-348-7246
  • Fax: 818-348-7248
Mailing address:
  • Phone: 818-348-7246
  • Fax: 818-348-7248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number20A 8461
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number20A 8461
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number20A8461
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: