Organization
LA LAKERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ADAM SILVER (VICE PRESIDENT NBA)
(310) 426-6000
Entity
Organization
Contact information
Practice address
2275 E MARIPOSA AVE, EL SEGUNDO, CA 90245-5029
(310) 426-6000
Mailing address
2275 E MARIPOSA AVE, EL SEGUNDO, CA 90245-5029
(310) 426-6000
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20-614414
THERAPEUTIC IMPAIRED PROFESSIONAL PROVIDER
CA
Enumeration date
04/06/2019
Last updated
03/16/2021
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