Provider Demographics
NPI:1255490082
Name:AURA, JAN (PHD)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:AURA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4230 OVERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-3736
Mailing Address - Country:US
Mailing Address - Phone:310-559-0200
Mailing Address - Fax:626-584-7139
Practice Address - Street 1:4230 OVERLAND AVE
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-3736
Practice Address - Country:US
Practice Address - Phone:310-559-0200
Practice Address - Fax:626-584-7139
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 10291103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical