Healthcare Provider Details

I. General information

NPI: 1639263148
Provider Name (Legal Business Name): RITA TENENBAUM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 N. PROSPECT AVE., SUITE 120
REDONDO BEACH CA
90277
US

IV. Provider business mailing address

510 N. PROSPECT AVE., SUITE 120
REDONDO BEACH CA
90277
US

V. Phone/Fax

Practice location:
  • Phone: 310-406-0827
  • Fax: 310-406-8378
Mailing address:
  • Phone: 310-406-0827
  • Fax: 310-406-8378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA55628
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: