Individual
ALLEN POURAVANES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
529 MAPLE AVE, LOS ANGELES, CA 90013-1511
(213) 430-6283
Mailing address
529 MAPLE AVE, LOS ANGELES, CA 90013-1511
(213) 430-6283
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
587382
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
163W90808X
—
CA
Enumeration date
04/08/2011
Last updated
04/08/2011
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