MEDICARE: REBEKKA YVETTE LERMA FNP

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	363LF0000X	Family Nurse Practitioner	95027744	CA

General Provider Information

NPI Number	:	1891561213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBEKKA YVETTE LERMA FNP

Provider Business Mailing Address
First Line	:	516 WEST ATEN ROAD
Second Line	:	SUITE 2
City	:	IMPERIAL
State	:	CA
Zip	:	92251-9805
Country	:	US
Telephone Number	:	760-355-7730
Fax Number	:

Provider Business Practice Location Address
First Line	:	1665 SOUTH IMPERIAL AVENUE
Second Line	:	SUITE C
City	:	EL CENTRO
State	:	CA
Zip	:	92243-4247
Country	:	US
Telephone Number	:	760-592-4783
Fax Number	:	760-545-0256

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

Provider Enumeration Date	:	11/27/2023
Last Update Date	:	06/20/2024

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