Individual
MS. AVITAL R GRAVANIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
127 S SAN VICENTE BLVD # A-6600, LOS ANGELES, CA 90048-3311
(310) 423-7900
(424) 315-4571
Mailing address
4140 W 190TH ST, TORRANCE, CA 90504-5513
(310) 423-7900
(424) 315-4571
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA60692
CA
363A00000X
Physician Assistant
—
CA
363AS0400X
Surgical Physician Assistant
60692
CA
Other
Enumeration date
09/03/2021
Last updated
11/08/2023
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