Provider Demographics
NPI:1225373269
Name:LAMPILA, BEVERLY REDSAR (PA-C)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:REDSAR
Last Name:LAMPILA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 S. SAN VICENTE BOULEVARD
Mailing Address - Street 2:SUITE A3100
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048
Mailing Address - Country:US
Mailing Address - Phone:310-423-3851
Mailing Address - Fax:310-423-0144
Practice Address - Street 1:127 S. SAN VICENTE BOULEVARD
Practice Address - Street 2:SUITE A3100
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048
Practice Address - Country:US
Practice Address - Phone:310-423-3851
Practice Address - Fax:310-423-0144
Is Sole Proprietor?:No
Enumeration Date:2012-12-03
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA22529363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant