MEDICARE: REBECCA WURZBURGER

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1689879181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA WURZBURGER

Provider Business Mailing Address
First Line	:	316 N ORANGE DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-2614
Country	:	US
Telephone Number	:	323-936-5552
Fax Number	:

Provider Business Practice Location Address
First Line	:	3321 EDITH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-4736
Country	:	US
Telephone Number	:	310-202-0669
Fax Number	:

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

Provider Enumeration Date	:	06/15/2007
Last Update Date	:	08/05/2008

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Directions to “ REBECCA WURZBURGER ” Practice Location

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