Healthcare Provider Details

I. General information

NPI: 1053071019
Provider Name (Legal Business Name): MS. REBECCA ANN MERIDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2021
Last Update Date: 03/21/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 W TORRANCE BLVD STE 100
REDONDO BEACH CA
90277-3600
US

IV. Provider business mailing address

1150 MCFARLAND AVE
WILMINGTON CA
90744-3630
US

V. Phone/Fax

Practice location:
  • Phone: 310-374-3300
  • Fax:
Mailing address:
  • Phone: 310-749-2370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-64766
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-17-28899
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: