Provider Demographics
NPI:1396088514
Name:KAVIANI, REBECCA ASHLEY (PA-C)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ASHLEY
Last Name:KAVIANI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:ASHLEY
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1333 S MAYFLOWER AVE 2ND FLR
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-5266
Mailing Address - Country:US
Mailing Address - Phone:626-775-3514
Mailing Address - Fax:626-408-3911
Practice Address - Street 1:903 S MARENGO AVE
Practice Address - Street 2:APT 4
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-4708
Practice Address - Country:US
Practice Address - Phone:305-815-8782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-05
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical