Provider Demographics
NPI:1114097847
Name:PAVELOFF, DANIEL J (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:PAVELOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10630 SEPULVEDA BLVD
Mailing Address - Street 2:#100
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1938
Mailing Address - Country:US
Mailing Address - Phone:818-933-4440
Mailing Address - Fax:818-698-4471
Practice Address - Street 1:10630 SEPULVEDA BLVD
Practice Address - Street 2:#100
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1938
Practice Address - Country:US
Practice Address - Phone:818-933-4440
Practice Address - Fax:818-698-4471
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG72593208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
G72593Medicare ID - Type Unspecified