Healthcare Provider Details

I. General information

NPI: 1659130664
Provider Name (Legal Business Name): KORINAH REBUSTES BRAZIL FNP-C, MSN, MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KORINAH ALEGRO REBUSTES

II. Dates (important events)

Enumeration Date: 03/14/2024
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23639 HAWTHORNE BLVD STE 102
TORRANCE CA
90505-5985
US

IV. Provider business mailing address

23639 HAWTHORNE BLVD STE 102
TORRANCE CA
90505-5985
US

V. Phone/Fax

Practice location:
  • Phone: 310-373-9980
  • Fax:
Mailing address:
  • Phone: 310-373-9980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95027853
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: