MEDICARE: PARK LANE GLOBAL INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	48181	CA

General Provider Information

NPI Number	:	1194914689
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARK LANE GLOBAL INC.

Provider Business Mailing Address
First Line	:	292 S LA CIENEGA BLVD
Second Line	:	102
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-3330
Country	:	US
Telephone Number	:	310-466-3738
Fax Number	:	310-967-0121

Provider Business Practice Location Address
First Line	:	10573 W PICO BLVD
Second Line	:	221
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-2333
Country	:	US
Telephone Number	:	310-466-3738
Fax Number	:	310-967-0121

Authorized Official
Title or Position	:	PRESIDENT/ CEO
Name	:	MR. AVESTA RASOULI
Credential	:	BA
Telephone Number	:	310-466-3738

Provider Enumeration Date	:	10/19/2007
Last Update Date	:	11/19/2007

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