MEDICARE: MRS. RITA LAU PRICE 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	PA18143	CA

General Provider Information

NPI Number	:	1528007747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RITA LAU PRICE PA-C

Provider Business Mailing Address
First Line	:	8930 S SEPULVEDA BLVD
Second Line	:	SUITE 114
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-3606
Country	:	US
Telephone Number	:	310-337-7171
Fax Number	:	310-337-1081

Provider Business Practice Location Address
First Line	:	8930 S SEPULVEDA BLVD
Second Line	:	SUITE 114
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-3606
Country	:	US
Telephone Number	:	310-337-7171
Fax Number	:	310-337-1081

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

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	03/04/2015

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Directions to “ MRS. RITA LAU PRICE PA-C” Practice Location

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