1083569982 NPI number — 35 BEL AIRE DRIVE OPCO, LLC

Table of content: ELIZABETH PAIGE LASSEN DO (NPI 1174720395)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083569982 NPI number — 35 BEL AIRE DRIVE OPCO, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
35 BEL AIRE DRIVE OPCO, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083569982
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9526 W PICO BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90035-1202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35 BEL AIRE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWPORT
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05855-4953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-928-9445
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/04/2026

Additional Information

Authorized Official

Authorized Official Last Name:
TRESS
Authorized Official First Name:
AVROHOM
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE VICE PRESIDENT
Authorized Official Telephone Number:
323-928-9445

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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