Healthcare Provider Details

I. General information

NPI: 1861943037
Provider Name (Legal Business Name): REBECCA GEBREMICHAEL AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2016
Last Update Date: 10/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL PLZ 540
LOS ANGELES CA
90095-0001
US

IV. Provider business mailing address

200 MEDICAL PLZ 540
LOS ANGELES CA
90095-0001
US

V. Phone/Fax

Practice location:
  • Phone: 310-909-4773
  • Fax:
Mailing address:
  • Phone: 310-909-4773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number3015
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: