Individual
MR. ANTON PAVLOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
640 N KEYSTONE ST STE B, BURBANK, CA 91506-1900
(818) 846-8666
(818) 846-8665
Mailing address
640 N KEYSTONE ST STE B, BURBANK, CA 91506-1900
(818) 846-8666
Taxonomy
Speciality
Code
Description
License number
State
246YR1600X
Registered Record Administrator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F5344662
DRIVER LICENSE
CA
Enumeration date
02/11/2019
Last updated
02/12/2019
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