Provider Demographics
NPI:1629198791
Name:ALFRED LAVI, D.O. PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ALFRED LAVI, D.O. PROFESSIONAL CORPORATION
Other - Org Name:UNITED CARE FAMILY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:213-383-3600
Mailing Address - Street 1:2324 W PICO BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-4002
Mailing Address - Country:US
Mailing Address - Phone:213-383-3600
Mailing Address - Fax:213-383-5300
Practice Address - Street 1:2324 W PICO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-4002
Practice Address - Country:US
Practice Address - Phone:310-210-5880
Practice Address - Fax:213-383-5300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7653207Q00000X
2084P2900X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX76530Medicaid
CAW18162Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
CA00AX76530Medicaid
CAW20A7653AMedicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NUMBE