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General NPI Number Information
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NPI Number | 1194914689
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Entity Type | Organization
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Legal Business Name | PARK LANE GLOBAL INC.
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Dates
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Enumeration Date | 10/19/2007
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Last Update Date | 11/19/2007
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Provider Practice Location Address
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Address Line | 10573 W PICO BLVD 221
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City | LOS ANGELES
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State | CA
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Zip | 90064-2333
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Country | US
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Telephone | 310-466-3738
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Fax | 310-967-0121
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Provider Business Mailing Address
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Address Line | 292 S LA CIENEGA BLVD 102
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-3330
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Country | US
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Telephone | 310-466-3738
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Fax | 310-967-0121
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Authorized Official
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Title or Position | PRESIDENT/ CEO
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Name | MR. AVESTA RASOULI
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Credential | BA
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Telephone | 310-466-3738
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 48181
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License Number State | CA
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