MEDICARE: LAUREN RACHEL ALBERSTONE 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

General Provider Information

NPI Number	:	1407500127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN RACHEL ALBERSTONE PA-C

Provider Business Mailing Address
First Line	:	11600 VENICE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-4014
Country	:	US
Telephone Number	:	805-910-6376
Fax Number	:

Provider Business Practice Location Address
First Line	:	11600 VENICE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-4014
Country	:	US
Telephone Number	:	805-910-6376
Fax Number	:

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

Provider Enumeration Date	:	02/10/2022
Last Update Date	:	11/27/2023

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