Provider Demographics
NPI:1184739039
Name:LAVI, ALFRED (DO)
Entity type:Individual
Prefix:
First Name:ALFRED
Middle Name:
Last Name:LAVI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7653207Q00000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX76530Medicaid
CA00AX76530Medicaid
CAI21496Medicare UPIN
CAW20A7653AMedicare ID - Type Unspecified