MEDICARE: REBECCA LAHIJANI 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	57820	CA
2	363A00000X	Physician Assistant	PA57820	CA

General Provider Information

NPI Number	:	1295370112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA LAHIJANI PA-C

Provider Business Mailing Address
First Line	:	201 S BUENA VISTA ST STE 300
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-4580
Country	:	US
Telephone Number	:	818-206-2539
Fax Number	:	818-804-5215

Provider Business Practice Location Address
First Line	:	201 S BUENA VISTA ST STE 300
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-4580
Country	:	US
Telephone Number	:	818-206-2539
Fax Number	:	818-804-5215

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

Provider Enumeration Date	:	11/14/2019
Last Update Date	:	03/02/2022

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