MEDICARE: EMILY LAVI

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	58632	CA

General Provider Information

NPI Number	:	1356969901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY LAVI

Provider Business Mailing Address
First Line	:	6106 PICKFORD ST APT 1
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-4566
Country	:	US
Telephone Number	:	310-562-9881
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 W 5TH ST STE 209
Second Line	:
City	:	SAN PEDRO
State	:	CA
Zip	:	90731-2752
Country	:	US
Telephone Number	:	310-521-6386
Fax Number	:

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

Provider Enumeration Date	:	07/09/2020
Last Update Date	:	03/20/2024

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Directions to “ EMILY LAVI ” Practice Location

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