Basic Information
| Provider Information | |||||||||
| NPI: | 1912135104 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LINANE | ||||||||
| FirstName: | AVRIEL | ||||||||
| MiddleName: | SARA | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 625 S FAIR OAKS AVE | ||||||||
| Address2: | #325 | ||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911052613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6265359344 | ||||||||
| FaxNumber: | 6265359395 | ||||||||
| Practice Location | |||||||||
| Address1: | 625 S FAIR OAKS AVE | ||||||||
| Address2: | #325 | ||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911052613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6265359344 | ||||||||
| FaxNumber: | 6265359395 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2009 | ||||||||
| LastUpdateDate: | 06/10/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2084N0400X | DO2526 | TN | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0400X | 20A11802 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.