Healthcare Provider Details

I. General information

NPI: 1396231593
Provider Name (Legal Business Name): ORRIN JACOB EZRALOW LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2018
Last Update Date: 07/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 ONSLOW GARDENS
LONDO LONDON
SW7 3PY
GB

IV. Provider business mailing address

5660 KELVIN AVE
WOODLAND HILLS CA
91367-6721
US

V. Phone/Fax

Practice location:
  • Phone: 310-271-9688
  • Fax:
Mailing address:
  • Phone: 310-271-9688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberCA2478
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: