Provider Demographics
NPI:1396231593
Name:EZRALOW, ORRIN JACOB (LAC)
Entity Type:Individual
Prefix:
First Name:ORRIN
Middle Name:JACOB
Last Name:EZRALOW
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5660 KELVIN AVE
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-6721
Mailing Address - Country:US
Mailing Address - Phone:310-271-9688
Mailing Address - Fax:
Practice Address - Street 1:43 ONSLOW GARDENS
Practice Address - Street 2:
Practice Address - City:LONDO
Practice Address - State:LONDON
Practice Address - Zip Code:SW7 3PY
Practice Address - Country:GB
Practice Address - Phone:310-271-9688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA2478171100000X
174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty