MEDICARE: MR. IRA IRADJ POURATIAN M.D.

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	208D00000X	General Practice Physician	CA A032128	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A032128	OTHER		CA STATE LICENSE #

General Provider Information

NPI Number	:	1548407703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. IRA IRADJ POURATIAN M.D.

Provider Business Mailing Address
First Line	:	325 NO. OAKHURST DRIVE
Second Line	:	#503
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-4149
Country	:	US
Telephone Number	:	213-393-9980
Fax Number	:	310-858-6656

Provider Business Practice Location Address
First Line	:	325 NO. OAKHURST DRIVE
Second Line	:	#503
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-4149
Country	:	US
Telephone Number	:	213-393-9980
Fax Number	:	310-858-6656

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

Provider Enumeration Date	:	01/09/2009
Last Update Date	:	03/07/2023

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