MEDICARE: REBEKAH LYNNE COHEN-GRONBERG NURSE PRACTITIONER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	95027007	CA

General Provider Information

NPI Number	:	1104674373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBEKAH LYNNE COHEN-GRONBERG NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	831 N HARBOR DR
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-2005
Country	:	US
Telephone Number	:	310-292-4111
Fax Number	:

Provider Business Practice Location Address
First Line	:	6420 E PACIFIC COAST HWY STE 157
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-4254
Country	:	US
Telephone Number	:	562-594-5523
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2024
Last Update Date	:	09/01/2025

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