MEDICARE: MEHRAN RAVAEI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	42480	CA

General Provider Information

NPI Number	:	1275031221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEHRAN RAVAEI

Provider Business Mailing Address
First Line	:	100 UCLA MEDICAL PLZ STE 150
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-7001
Country	:	US
Telephone Number	:	310-208-2340
Fax Number	:	310-209-2397

Provider Business Practice Location Address
First Line	:	100 UCLA MEDICAL PLZ STE 150
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-7001
Country	:	US
Telephone Number	:	310-208-2340
Fax Number	:	310-209-2397

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2018
Last Update Date	:	01/24/2018

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Directions to “ MEHRAN RAVAEI ” Practice Location

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