Provider Demographics
NPI:1548598212
Name:LALA, JOHN
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:LALA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4920 DENNY DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-6205
Mailing Address - Country:US
Mailing Address - Phone:757-348-5197
Mailing Address - Fax:757-337-2810
Practice Address - Street 1:4920 DENNY DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-6205
Practice Address - Country:US
Practice Address - Phone:757-348-5197
Practice Address - Fax:757-337-2810
Is Sole Proprietor?:No
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2705118606A171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications