Provider Demographics
NPI:1497006688
Name:KAMRAVAPOUR, TEHILA
Entity Type:Individual
Prefix:
First Name:TEHILA
Middle Name:
Last Name:KAMRAVAPOUR
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 1:3551 TROUSDALE PKWY
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90089-0041
Mailing Address - Country:US
Mailing Address - Phone:213-740-2311
Mailing Address - Fax:
Practice Address - Street 1:3551 TROUSDALE PKWY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-0041
Practice Address - Country:US
Practice Address - Phone:213-740-2311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-27
Last Update Date:2014-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program