Provider Demographics
NPI:1275031221
Name:RAVAEI, MEHRAN
Entity Type:Individual
Prefix:
First Name:MEHRAN
Middle Name:
Last Name:RAVAEI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 UCLA MEDICAL PLZ STE 150
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-7001
Mailing Address - Country:US
Mailing Address - Phone:310-208-2340
Mailing Address - Fax:310-209-2397
Practice Address - Street 1:100 UCLA MEDICAL PLZ STE 150
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-7001
Practice Address - Country:US
Practice Address - Phone:310-208-2340
Practice Address - Fax:310-209-2397
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42480183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist