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NPI Code Detail

MEDICARE: REBECCA CORNELIUS

MEDICARE: REBECCA CORNELIUS
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
11041C0700XClinical Social Worker
21041C0700XClinical Social Worker98665CA

General Provider Information

NPI Number : 1346629458
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA CORNELIUS
Provider Business Mailing Address
First Line : PO BOX 1977
Second Line :
City : GLENDORA
State : CA
Zip : 91740-1977
Country : US
Telephone Number : 626-499-7804
Fax Number :
Provider Business Practice Location Address
First Line : 4633 OLD IRONSIDES DR STE 304
Second Line :
City : SANTA CLARA
State : CA
Zip : 95054-1846
Country : US
Telephone Number : 323-205-7088
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2015
Last Update Date : 08/11/2025

Similar Medicare Providers

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1609383082 — DR. MICHAEL LYNN HALL DNPC APRN FNP PMHNP
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Practice Location Address:
4633 OLD IRONSIDES DR STE 304
SANTA CLARA, CA
95054-1846
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1972138238 — SUD SPECIALTY GROUP - CA
Practice Location Address:
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Directions to “ REBECCA CORNELIUS ” Practice Location

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