MEDICARE: DR. REBECCA MARGARET ROTENBERG M.D.

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	208D00000X	General Practice Physician	A050009	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A050009	OTHER	CA	MEDICAL BOARD OF CALIFORNIA

General Provider Information

NPI Number	:	1629304118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REBECCA MARGARET ROTENBERG M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1733
Second Line	:
City	:	PACIFIC PALISADES
State	:	CA
Zip	:	90272-1733
Country	:	US
Telephone Number	:	310-266-8406
Fax Number	:	310-496-2758

Provider Business Practice Location Address
First Line	:	9437 OAKMORE RD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-4138
Country	:	US
Telephone Number	:	310-266-8406
Fax Number	:	310-496-2758

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

Provider Enumeration Date	:	10/19/2009
Last Update Date	:	12/10/2022

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