Provider Demographics
NPI:1518313451
Name:PURAVATH, ABIN P (MD)
Entity Type:Individual
Prefix:DR
First Name:ABIN
Middle Name:P
Last Name:PURAVATH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8723 ALDEN DR # 213C
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-3692
Mailing Address - Country:US
Mailing Address - Phone:424-314-0963
Mailing Address - Fax:310-423-6898
Practice Address - Street 1:8723 ALDEN DR STE 250
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-3693
Practice Address - Country:US
Practice Address - Phone:310-423-6257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA192533207RR0500X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program