Healthcare Provider Details

I. General information

NPI: 1790068120
Provider Name (Legal Business Name): REBECCA WINDERMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA WINDERMAN MD

II. Dates (important events)

Enumeration Date: 09/22/2011
Last Update Date: 03/10/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

8906 135TH ST
RICHMOND HILL NY
11418-2828
US

V. Phone/Fax

Practice location:
  • Phone: 323-660-2450
  • Fax:
Mailing address:
  • Phone: 718-206-7591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberC200560
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: