=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417780966
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBECCA KARIN HENSON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2024
-----------------------------------------------------
Last Update Date | 08/21/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 415 N CRESCENT DR STE 340
-----------------------------------------------------
City | BEVERLY HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90210-4884
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-382-4763
-----------------------------------------------------
Fax | 310-388-5809
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 415 N CRESCENT DR STE 340
-----------------------------------------------------
City | BEVERLY HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90210-4884
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-382-4763
-----------------------------------------------------
Fax | 310-388-5809
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | F07241388
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 95110213
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------