Provider Demographics
NPI:1295291607
Name:PAVLOV, ANTON
Entity type:Individual
Prefix:MR
First Name:ANTON
Middle Name:
Last Name:PAVLOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 N KEYSTONE ST STE B
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-1900
Mailing Address - Country:US
Mailing Address - Phone:818-846-8666
Mailing Address - Fax:
Practice Address - Street 1:640 N KEYSTONE ST STE B
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-1900
Practice Address - Country:US
Practice Address - Phone:818-846-8666
Practice Address - Fax:818-846-8665
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-11
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246YR1600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health InformationRegistered Record Administrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF5344662OtherDRIVER LICENSE