Provider Demographics
NPI:1568573251
Name:RAVAEI, SEAN S (DPM)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:S
Last Name:RAVAEI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8929 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-1938
Mailing Address - Country:US
Mailing Address - Phone:310-855-8936
Mailing Address - Fax:413-643-6360
Practice Address - Street 1:8929 WILSHIRE BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1938
Practice Address - Country:US
Practice Address - Phone:310-855-8936
Practice Address - Fax:413-643-6360
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004502L213E00000X
CAE4392213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE4392Medicare ID - Type Unspecified
PAU71613Medicare UPIN
CAE4392Medicare ID - Type Unspecified
PA014029Medicare ID - Type Unspecified