Provider Demographics
NPI:1871762070
Name:LASLEY, KEVIN DARNEIL
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:DARNEIL
Last Name:LASLEY
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 1:313 E 113TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90061-3019
Mailing Address - Country:US
Mailing Address - Phone:323-418-8113
Mailing Address - Fax:323-920-7691
Practice Address - Street 1:313 E 113TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90061-3019
Practice Address - Country:US
Practice Address - Phone:323-418-8113
Practice Address - Fax:323-920-7691
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA3975427177F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging