Provider Demographics
NPI:1457575169
Name:DANOVITCH, ITAI (ITAI DANOVITCH)
Entity Type:Individual
Prefix:DR
First Name:ITAI
Middle Name:
Last Name:DANOVITCH
Suffix:
Gender:M
Credentials:ITAI DANOVITCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8730 ALDEN DRIVE
Mailing Address - Street 2:SUITE W-101
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048
Mailing Address - Country:US
Mailing Address - Phone:310-423-8198
Mailing Address - Fax:310-423-0114
Practice Address - Street 1:8730 ALDEN DRIVE
Practice Address - Street 2:SUITE W-101
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048
Practice Address - Country:US
Practice Address - Phone:310-423-8198
Practice Address - Fax:310-423-0114
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA991192084P0800X
NY2329482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry