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NPI Code Detail

MEDICARE: ANN MARIE VAVRA PA-C

MEDICARE: ANN MARIE VAVRA 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
1363AM0700XMedical Physician AssistantPA16577CA

General Provider Information

NPI Number : 1932217528
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANN MARIE VAVRA PA-C
Provider Business Mailing Address
First Line : 18646 OXNARD ST
Second Line :
City : TARZANA
State : CA
Zip : 91356-1411
Country : US
Telephone Number : 818-996-1051
Fax Number :
Provider Business Practice Location Address
First Line : 18646 OXNARD ST
Second Line :
City : TARZANA
State : CA
Zip : 91356-1411
Country : US
Telephone Number : 818-996-1051
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2006
Last Update Date : 07/08/2007

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Directions to “ ANN MARIE VAVRA PA-C” Practice Location

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