Healthcare Provider Details

I. General information

NPI: 1831576099
Provider Name (Legal Business Name): REBECCA SWIMMER D.V.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2015
Last Update Date: 04/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11301 W OLYMPIC BLVD # 304
LOS ANGELES CA
90064-1653
US

IV. Provider business mailing address

11301 W OLYMPIC BLVD # 304
LOS ANGELES CA
90064-1653
US

V. Phone/Fax

Practice location:
  • Phone: 310-993-9750
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number18841
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number090010907
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number7040
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: