Healthcare Provider Details

I. General information

NPI: 1164264107
Provider Name (Legal Business Name): REBORN HEALTH SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17671 MORNING SUN CT
RIVERSIDE CA
92503-6574
US

IV. Provider business mailing address

17671 MORNING SUN CT
RIVERSIDE CA
92503-6574
US

V. Phone/Fax

Practice location:
  • Phone: 951-965-8501
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: REBECA LUSCA
Title or Position: OWNER
Credential: RDN
Phone: 951-965-8501