MEDICARE: MRS. REBECCA ASHLEY KAVIANI PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	363A00000X	Physician Assistant
2	363AM0700X	Medical Physician Assistant
3	363AS0400X	Surgical Physician Assistant

General Provider Information

NPI Number	:	1396088514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REBECCA ASHLEY KAVIANI PA-C

Provider Business Mailing Address
First Line	:	1333 S MAYFLOWER AVE 2ND FLR
Second Line	:
City	:	MONROVIA
State	:	CA
Zip	:	91016-5266
Country	:	US
Telephone Number	:	626-775-3514
Fax Number	:	626-408-3911

Provider Business Practice Location Address
First Line	:	903 S MARENGO AVE
Second Line	:	APT 4
City	:	PASADENA
State	:	CA
Zip	:	91106-4708
Country	:	US
Telephone Number	:	305-815-8782
Fax Number	:

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

Provider Enumeration Date	:	04/05/2013
Last Update Date	:	09/10/2015

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