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General NPI Number Information
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NPI Number | 1255866703
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Entity Type | Individual
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Provider Name | JACOB POURAT
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Gender | Male
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Dates
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Enumeration Date | 04/21/2017
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Last Update Date | 07/13/2023
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Provider Practice Location Address
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Address Line | 2010 ZONAL AVE STE 1P-2
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City | LOS ANGELES
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State | CA
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Zip | 90033-1026
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Country | US
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Telephone | 323-409-4942
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Fax |
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Provider Business Mailing Address
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Address Line | LACUSC 2010 ZONAL AVE. SUITE 1P-2
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City | LOS ANGELES
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State | CA
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Zip | 90033
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Country | US
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Telephone | 323-409-4942
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A156868
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A156868
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License Number State | CA
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