Provider Demographics
NPI:1528007747
Name:PRICE, RITA LAU (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:RITA
Middle Name:LAU
Last Name:PRICE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:RITA
Other - Middle Name:
Other - Last Name:LAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:8930 S SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3606
Mailing Address - Country:US
Mailing Address - Phone:310-337-7171
Mailing Address - Fax:310-337-1081
Practice Address - Street 1:8930 S SEPULVEDA BLVD
Practice Address - Street 2:SUITE 114
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3606
Practice Address - Country:US
Practice Address - Phone:310-337-7171
Practice Address - Fax:310-337-1081
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18143363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q57364Medicare UPIN