Provider Demographics
NPI:1700276680
Name:ALAVI, DIANA
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:ALAVI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3180 WILLOW LN STE 114
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-4984
Mailing Address - Country:US
Mailing Address - Phone:818-232-8432
Mailing Address - Fax:818-232-8433
Practice Address - Street 1:3180 WILLOW LN STE 114
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-4984
Practice Address - Country:US
Practice Address - Phone:818-232-8432
Practice Address - Fax:818-232-8433
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-29
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAC198396207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program