Park Lane Global Inc.

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

48181 Issued in CA

Legal business name

PARK LANE GLOBAL INC.

Doing business as

Provicare

Practice address

10573 W Pico Blvd
221
Los Angeles, CA 90064-2333

Phone

(310) 466-3738

Fax

(310) 967-0121

NPI assigned

Oct 19, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Avesta Rasouli, BA

Title

President/ Ceo

Phone

(310) 466-3738

Specialties & licenses 1

Addresses

Other names 1

• PROVICARE Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1192752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195430400000",
    "number": "1194914689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "292 S LA CIENEGA BLVD",
            "address_2": "102",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902113330",
            "telephone_number": "310-466-3738",
            "fax_number": "310-967-0121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10573 W PICO BLVD",
            "address_2": "221",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900642333",
            "telephone_number": "310-466-3738",
            "fax_number": "310-967-0121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK LANE GLOBAL INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-19",
        "last_updated": "2007-11-19",
        "status": "A",
        "authorized_official_last_name": "RASOULI",
        "authorized_official_first_name": "AVESTA",
        "authorized_official_title_or_position": "PRESIDENT/ CEO",
        "authorized_official_telephone_number": "310-466-3738",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "BA"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "CA",
            "license": "48181",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROVICARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Michael David Pariser, PSY.D.
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• Park & Park Chiropractic Apc (CareOne Spinal Center)
• Park Professional Dental Corp (Smile Dental of Los Angeles)
• Jennifer Park-Cruz, DR
• Ellen Park-Nakashima, LCSW
• Esther Park-Weston
• Aaron Park, DPT

• Durable Medical Equipment & Medical Supplies in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Durable Medical Equipment & Medical Supplies in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.