MEDICARE: LYUBOV LUPYAN-TEYTELMAN P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA18793	CA

General Provider Information

NPI Number	:	1033230693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYUBOV LUPYAN-TEYTELMAN P.A.

Provider Business Mailing Address
First Line	:	1261 TRAVIS BLVD
Second Line	:	SUITE 170 GASTROENTEROLOGY
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-4825
Country	:	US
Telephone Number	:	707-399-9200
Fax Number	:	707-399-9222

Provider Business Practice Location Address
First Line	:	1261 TRAVIS BLVD
Second Line	:	SUITE 170
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-4825
Country	:	US
Telephone Number	:	707-399-9200
Fax Number	:	707-399-9222

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	02/24/2015

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