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General NPI Number Information
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NPI Number | 1144995465
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Entity Type | Individual
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Provider Name | LILI MARLENE BARAJAS PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/10/2021
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Last Update Date | 12/22/2023
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Provider Practice Location Address
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Address Line | 14426 GILMORE ST STE B
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City | VAN NUYS
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State | CA
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Zip | 91401-1429
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Country | US
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Telephone | 818-614-3713
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Fax |
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Provider Business Mailing Address
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Address Line | 1047 W 50TH ST
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City | LOS ANGELES
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State | CA
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Zip | 90037-2923
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Country | US
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Telephone | 213-447-2404
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA59878
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License Number State | CA
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