Provider Demographics
NPI:1548283526
Name:LAVIAN, CYRUS RAFAEL (MD)
Entity type:Individual
Prefix:
First Name:CYRUS
Middle Name:RAFAEL
Last Name:LAVIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15310 ROSCOE BLVD
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-4303
Mailing Address - Country:US
Mailing Address - Phone:818-830-9999
Mailing Address - Fax:818-830-9910
Practice Address - Street 1:15310 ROSCOE BLVD
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-4303
Practice Address - Country:US
Practice Address - Phone:818-830-9999
Practice Address - Fax:818-830-9910
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA044927207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE49201Medicare UPIN