MEDICARE: REX EDWARD THORPE RADT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	R1550780224	CA

General Provider Information

NPI Number	:	1336091511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REX EDWARD THORPE RADT

Provider Business Mailing Address
First Line	:	1138 S LA CIENEGA BLVD APT 21
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-2589
Country	:	US
Telephone Number	:	818-636-9606
Fax Number	:	818-636-9606

Provider Business Practice Location Address
First Line	:	1138 S LA CIENEGA BLVD APT 21
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-2589
Country	:	US
Telephone Number	:	818-636-9606
Fax Number	:	818-636-9606

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2026
Last Update Date	:	02/11/2026

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