Provider Demographics
NPI:1467037044
Name:FURLAN, AMELIA CATERINA
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:CATERINA
Last Name:FURLAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11127 VENICE BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-6999
Mailing Address - Country:US
Mailing Address - Phone:310-880-4820
Mailing Address - Fax:
Practice Address - Street 1:3534 MILITARY AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-6104
Practice Address - Country:US
Practice Address - Phone:310-880-4820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH84036183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist