Healthcare Provider Details

I. General information

NPI: 1215600911
Provider Name (Legal Business Name): REBEKAH FELLEKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2021
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8019 COMPTON AVE
LOS ANGELES CA
90001-3409
US

IV. Provider business mailing address

8019 COMPTON AVE
LOS ANGELES CA
90001-3409
US

V. Phone/Fax

Practice location:
  • Phone: 323-586-7333
  • Fax:
Mailing address:
  • Phone: 323-586-7333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number134457
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number91712
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: