MEDICARE: REBECCA ELIZABETH EBERLIN PHD

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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1790970655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA ELIZABETH EBERLIN PHD

Provider Business Mailing Address
First Line	:	11400 W OLYMPIC BLVD
Second Line	:	SUITE 200
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-1550
Country	:	US
Telephone Number	:	424-231-5705
Fax Number	:

Provider Business Practice Location Address
First Line	:	11400 W OLYMPIC BLVD
Second Line	:	SUITE 200
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-1550
Country	:	US
Telephone Number	:	424-231-5705
Fax Number	:

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

Provider Enumeration Date	:	09/12/2007
Last Update Date	:	04/30/2014

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