Healthcare Provider Details

I. General information

NPI: 1619495967
Provider Name (Legal Business Name): REBECCA ELIZABETH GERL RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2017
Last Update Date: 08/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3445 PACIFIC COAST HWY STE 100
TORRANCE CA
90505-6659
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-542-6333
  • Fax: 310-326-2236
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number723185
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: