1588804124 NPI number — EAST VALLEY PANORAMA, INC

Table of content: MS. LORELLE LAYDEN BAUM DENTAL ASSISTANT (NPI 1457835647)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588804124 NPI number — EAST VALLEY PANORAMA, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST VALLEY PANORAMA, INC
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:
6
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:
1588804124
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18345 VENTURA BLVD.
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
TARZANA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91356-4232
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-371-5097
Provider Business Mailing Address Fax Number:
818-716-8437

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18345 VENTURA BLVD.
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
TARZANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91356-4232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-371-5097
Provider Business Practice Location Address Fax Number:
818-716-8437
Provider Enumeration Date:
02/23/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LUMMER
Authorized Official First Name:
SOFYA
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE-PRESIDENT
Authorized Official Telephone Number:
818-371-5097

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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