Basic Information
Provider Information
NPI: 1053640987
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALLOUN
FirstName: HAVA
MiddleName: GABRIELLE
NamePrefix: MRS.
NameSuffix:  
Credential: OTR
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 26560 AGOURA RD
Address2:  
City: CALABASAS
State: CA
PostalCode: 913021926
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 26560 AGOURA RD
Address2:  
City: CALABASAS
State: CA
PostalCode: 913021926
CountryCode: US
TelephoneNumber: 8188801260
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/24/2009
LastUpdateDate: 12/24/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000X999510CAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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