MEDICARE: REBECCA KARIN HENSON

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	163W00000X	Registered Nurse	95110213	CA
2	363L00000X	Nurse Practitioner	F07241388	CA

General Provider Information

NPI Number	:	1417780966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA KARIN HENSON

Provider Business Mailing Address
First Line	:	415 N CRESCENT DR STE 340
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-4884
Country	:	US
Telephone Number	:	562-382-4763
Fax Number	:	310-388-5809

Provider Business Practice Location Address
First Line	:	415 N CRESCENT DR STE 340
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-4884
Country	:	US
Telephone Number	:	562-382-4763
Fax Number	:	310-388-5809

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

Provider Enumeration Date	:	08/21/2024
Last Update Date	:	08/21/2024

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