MEDICARE: SYDNEY REBECCA GUNN PA-C

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	5021	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1094077	OTHER		NCPAA #

General Provider Information

NPI Number	:	1083998157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYDNEY REBECCA GUNN PA-C

Provider Business Mailing Address
First Line	:	4237 VIA MARINA APT 501
Second Line	:
City	:	MARINA DEL REY
State	:	CA
Zip	:	90292-4555
Country	:	US
Telephone Number	:	310-985-7878
Fax Number	:

Provider Business Practice Location Address
First Line	:	510 WILSHIRE BLVD STE 101
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90401-1404
Country	:	US
Telephone Number	:	310-400-6181
Fax Number	:

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

Provider Enumeration Date	:	10/06/2011
Last Update Date	:	04/29/2024

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