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General NPI Number Information
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NPI Number | 1821424375
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Entity Type | Individual
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Provider Name | REBECCA ROSE BONNEVILLE NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 09/16/2013
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 22704 VENTURA BLVD UNIT 115
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City | WOODLAND HILLS
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State | CA
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Zip | 91364-1333
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Country | US
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Telephone | 323-900-5091
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Fax | 323-538-6512
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Provider Business Mailing Address
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Address Line | 22704 VENTURA BLVD UNIT 115
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City | WOODLAND HILLS
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State | CA
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Zip | 91364-1333
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Country | US
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Telephone | 323-900-5091
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Fax | 323-538-6512
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 1821424375
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 22278
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | CA
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