Provider Demographics
NPI:1104674373
Name:COHEN-GRONBERG, REBEKAH LYNNE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:LYNNE
Last Name:COHEN-GRONBERG
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 N HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-2005
Mailing Address - Country:US
Mailing Address - Phone:310-292-4111
Mailing Address - Fax:
Practice Address - Street 1:6420 E PACIFIC COAST HWY STE 157
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-4254
Practice Address - Country:US
Practice Address - Phone:562-594-5523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-10
Last Update Date:2025-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95027007363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily