Healthcare Provider Details

I. General information

NPI: 1730972084
Provider Name (Legal Business Name): REBECCA BLYTHE CHITTENDEN RRA, RT(R)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2025
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6440 SOUTH ST
LAKEWOOD CA
90713-1713
US

IV. Provider business mailing address

1827 E 4TH ST APT 10
LONG BEACH CA
90802-3810
US

V. Phone/Fax

Practice location:
  • Phone: 562-627-0903
  • Fax: 562-627-0923
Mailing address:
  • Phone: 315-420-3443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License NumberRHF115985
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: