Healthcare Provider Details

I. General information

NPI: 1962360636
Provider Name (Legal Business Name): REBECCA BLANCHARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2026
Last Update Date: 01/12/2026
Certification Date: 01/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16360 ROSCOE BLVD FL 2
VAN NUYS CA
91406-1219
US

IV. Provider business mailing address

213 W 5TH ST
SAN DIMAS CA
91773-2129
US

V. Phone/Fax

Practice location:
  • Phone: 818-901-4830
  • Fax:
Mailing address:
  • Phone: 626-808-7749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: