Provider Demographics
NPI:1972856342
Name:LAVI, DAHLIA (PA-C)
Entity Type:Individual
Prefix:
First Name:DAHLIA
Middle Name:
Last Name:LAVI
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 1:8920 WILSHIRE BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2003
Mailing Address - Country:US
Mailing Address - Phone:310-553-5203
Mailing Address - Fax:
Practice Address - Street 1:8920 WILSHIRE BLVD STE 310
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2003
Practice Address - Country:US
Practice Address - Phone:310-553-5203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-22
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22456363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant