Individual
MR. LAVELLE LARUE II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4500 PARK GRANADA, CALABASAS, CA 91302-1663
(213) 667-6944
Mailing address
4500 PARK GRANADA, CALABASAS, CA 91302-1663
(213) 667-6944
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
8TVP754
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
88-1668629
—
CA
Enumeration date
11/03/2022
Last updated
11/03/2022
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