Provider Demographics
NPI:1912135104
Name:LINANE, AVRIEL SARA (DO)
Entity Type:Individual
Prefix:
First Name:AVRIEL
Middle Name:SARA
Last Name:LINANE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 S FAIR OAKS AVE
Mailing Address - Street 2:#325
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2613
Mailing Address - Country:US
Mailing Address - Phone:626-535-9344
Mailing Address - Fax:626-535-9395
Practice Address - Street 1:625 S FAIR OAKS AVE
Practice Address - Street 2:#325
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2613
Practice Address - Country:US
Practice Address - Phone:626-535-9344
Practice Address - Fax:626-535-9395
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TNDO25262084N0400X
CA20A118022084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program