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General NPI Number Information
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NPI Number | 1508925439
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Entity Type | Organization
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Legal Business Name | MIRAGE PAIN AND REHABILITATION ASSOCIATES A MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 02/25/2015
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Provider Practice Location Address
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Address Line | 72780 COUNTRY CLUB DR. SUITE C-300
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-4150
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Country | US
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Telephone | 760-341-5550
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Fax | 760-341-6050
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Provider Business Mailing Address
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Address Line | PO BOX 38
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270
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Country | US
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Telephone | 760-341-5550
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Fax | 760-341-6050
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Authorized Official
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Title or Position | PARTNER
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Name | DR. ALBERT LAI
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Credential | M.D.
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Telephone | 760-341-5550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A86192
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2081H0002X
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Taxonomy Name | Hospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 20A7784
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 2081H0002X
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Taxonomy Name | Hospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2081H0002X
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Taxonomy Name | Hospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | A86192
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License Number State | CA
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