# PARK LANE GLOBAL INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PROVICARE
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194914689
- **Authorized official:** MR. AVESTA RASOULI BA (PRESIDENT/ CEO)
- **Authorized official phone:** (310) 466-3738

## Contact information

- **Practice address:** 10573 W PICO BLVD, 221, LOS ANGELES, CA 90064-2333
- **Practice address phone:** (310) 466-3738
- **Practice address fax:** (310) 967-0121
- **Mailing address:** 292 S LA CIENEGA BLVD, 102, BEVERLY HILLS, CA 90211-3330
- **Mailing address phone:** (310) 466-3738
- **Mailing address fax:** (310) 967-0121

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 48181 | CA | Yes |

## Other

- **Enumeration date:** 10/19/2007
- **Last updated:** 11/19/2007