Healthcare Provider Details

I. General information

NPI: 1689879181
Provider Name (Legal Business Name): REBECCA WURZBURGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 08/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3321 EDITH ST
LOS ANGELES CA
90064-4736
US

IV. Provider business mailing address

316 N ORANGE DR
LOS ANGELES CA
90036-2614
US

V. Phone/Fax

Practice location:
  • Phone: 310-202-0669
  • Fax:
Mailing address:
  • Phone: 323-936-5552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: