MEDICARE: MICHELLE REBECCA FOULADIAN 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	363AM0700X	Medical Physician Assistant	51947	CA

General Provider Information

NPI Number	:	1033512439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE REBECCA FOULADIAN PA-C

Provider Business Mailing Address
First Line	:	29229 CANWOOD ST STE 112
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-1561
Country	:	US
Telephone Number	:	818-501-7276
Fax Number	:

Provider Business Practice Location Address
First Line	:	29229 CANWOOD ST STE 112
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-1561
Country	:	US
Telephone Number	:	818-501-7276
Fax Number	:

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

Provider Enumeration Date	:	09/30/2014
Last Update Date	:	01/13/2026

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