Provider Demographics
NPI:1548407703
Name:POURATIAN, IRA IRADJ (MD)
Entity Type:Individual
Prefix:MR
First Name:IRA
Middle Name:IRADJ
Last Name:POURATIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 NO. OAKHURST DRIVE
Mailing Address - Street 2:#503
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4149
Mailing Address - Country:US
Mailing Address - Phone:213-393-9980
Mailing Address - Fax:310-858-6656
Practice Address - Street 1:325 NO. OAKHURST DRIVE
Practice Address - Street 2:#503
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4149
Practice Address - Country:US
Practice Address - Phone:213-393-9980
Practice Address - Fax:310-858-6656
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA A032128208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
A032128OtherCA STATE LICENSE #
BP8100694OtherDEA#