Provider Demographics
NPI:1295370112
Name:LAHIJANI, REBECCA (PA-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:LAHIJANI
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 1:201 S BUENA VISTA ST STE 300
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4580
Mailing Address - Country:US
Mailing Address - Phone:818-206-2539
Mailing Address - Fax:818-804-5215
Practice Address - Street 1:201 S BUENA VISTA ST STE 300
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4580
Practice Address - Country:US
Practice Address - Phone:818-206-2539
Practice Address - Fax:818-804-5215
Is Sole Proprietor?:No
Enumeration Date:2019-11-14
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57820363A00000X
CAPA57820363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant