Individual
ATA DANIEL REZVANPOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6041 CADILLAC AVE, LOS ANGELES, CA 90034-1702
(323) 857-2000
(323) 857-2619
Mailing address
393 E WALNUT ST, 3RD FLOOR PHR SYSTEMS, PASADENA, CA 91188-0001
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
Primary
A36429
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A364290
—
CA
Enumeration date
01/08/2007
Last updated
11/22/2021
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