Healthcare Provider Details

I. General information

NPI: 1801733548
Provider Name (Legal Business Name): RARE BIRD WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 AVIATION BLVD APT 12
REDONDO BEACH CA
90278-1900
US

IV. Provider business mailing address

2700 AVIATION BLVD APT 12
REDONDO BEACH CA
90278-1900
US

V. Phone/Fax

Practice location:
  • Phone: 424-327-3832
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER EVANS
Title or Position: BOARD TREASURER
Credential:
Phone: 424-327-3832