Individual ProviderJacob PouratPsychiatry & NeurologyAllopathic & Osteopathic PhysiciansPractice Address2010 Zonal Ave Ste 1p-2, Los Angeles, CA 90033-1026(323) 409-4942PECOS EnrollmentBased on the most recent information from CMS, provider Jacob Pourat is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1255866703Provider TypeIndividualFull NamePourat, JacobGenderMaleSole ProprietorNoEnumeration Date4/21/2017Last Updated7/13/2023Contact InformationPractice LocationPractice Address2010 Zonal Ave Ste 1p-2, Los Angeles, CA 90033-1026Phone(323) 409-4942FaxUnlisted FaxMailing LocationMailing AddressLacusc, 2010 Zonal Ave. Suite 1p-2, Los Angeles, CA 90033Phone(323) 409-4942FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode2084P0800XPrimaryDescriptionPsychiatry & NeurologyAllopathic & Osteopathic PhysiciansLicenseA156868CaliforniaCode174400000XDescriptionSpecialistOther Service ProvidersLicenseA156868CaliforniaCode390200000XDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted Issuer