Provider Demographics
NPI:1124856588
Name:SOWELL, TAVAION
Entity type:Individual
Prefix:
First Name:TAVAION
Middle Name:
Last Name:SOWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6041 BRISTOL PKWY # 100
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6601
Mailing Address - Country:US
Mailing Address - Phone:213-425-5507
Mailing Address - Fax:
Practice Address - Street 1:6041 BRISTOL PKWY # 100
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6601
Practice Address - Country:US
Practice Address - Phone:213-425-5507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management