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General NPI Number Information
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NPI Number | 1669778056
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Entity Type | Individual
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Provider Name | MAURICIO DE LA LAMA MD
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Gender | Male
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Dates
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Enumeration Date | 02/01/2011
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Last Update Date | 09/25/2015
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Provider Practice Location Address
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Address Line | 400 E 71ST ST 4A
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City | NEW YORK
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State | NY
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Zip | 10021-4808
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Country | US
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Telephone | 312-213-0200
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Fax |
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Provider Business Mailing Address
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Address Line | 400 E 71ST ST 4A
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City | NEW YORK
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State | NY
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Zip | 10021-4808
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Country | US
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Telephone | 312-213-0200
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | A121020
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License Number State | CA
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