Organization
PARK LANE GLOBAL INC.
Active
Other names
PROVICARE
Organization subpart
No
Provider details
NPI number
Authorized official
MR. AVESTA RASOULI BA (PRESIDENT/ CEO)
(310) 466-3738
Entity
Organization
Contact information
Practice address
10573 W PICO BLVD, 221, LOS ANGELES, CA 90064-2333
(310) 466-3738
(310) 967-0121
Mailing address
292 S LA CIENEGA BLVD, 102, BEVERLY HILLS, CA 90211-3330
(310) 466-3738
(310) 967-0121
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
48181
CA
Other
Enumeration date
10/19/2007
Last updated
11/19/2007
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