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NPI Code Detail

MEDICARE: MS. REBECCA A PRINE MSW INTERN

MEDICARE: MS. REBECCA A PRINE MSW INTERN
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
1104100000XSocial Worker29890CA
2104100000XSocial Worker

General Provider Information

NPI Number : 1275759102
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. REBECCA A PRINE MSW INTERN
Provider Business Mailing Address
First Line : 9754 HIGHWAY 79
Second Line :
City : DESCANSO
State : CA
Zip : 91916-9771
Country : US
Telephone Number : 323-697-0001
Fax Number :
Provider Business Practice Location Address
First Line : 4018 CITY TERRACE DR
Second Line :
City : LOS ANGELES
State : CA
Zip : 90063-1242
Country : US
Telephone Number : 323-268-3219
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2007
Last Update Date : 10/01/2024

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