Provider Demographics
NPI:1417780966
Name:HENSON, REBECCA KARIN
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:KARIN
Last Name:HENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:KARIN
Other - Last Name:BARRERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:415 N CRESCENT DR STE 340
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4884
Mailing Address - Country:US
Mailing Address - Phone:562-382-4763
Mailing Address - Fax:310-388-5809
Practice Address - Street 1:415 N CRESCENT DR STE 340
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4884
Practice Address - Country:US
Practice Address - Phone:562-382-4763
Practice Address - Fax:310-388-5809
Is Sole Proprietor?:No
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95110213163W00000X
CAF07241388363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse