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General NPI Number Information
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NPI Number | 1356969901
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Entity Type | Individual
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Provider Name | EMILY LAVI
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Gender | Female
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Dates
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Enumeration Date | 07/09/2020
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Last Update Date | 03/20/2024
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Provider Practice Location Address
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Address Line | 350 W 5TH ST STE 209
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City | SAN PEDRO
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State | CA
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Zip | 90731-2752
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Country | US
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Telephone | 310-521-6386
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Fax |
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Provider Business Mailing Address
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Address Line | 6106 PICKFORD ST APT 1
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City | LOS ANGELES
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State | CA
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Zip | 90035-4566
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Country | US
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Telephone | 310-562-9881
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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 | 58632
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License Number State | CA
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