Provider Demographics
NPI:1528757325
Name:RUTHER, REBEKAH DOROTHY (NP)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:DOROTHY
Last Name:RUTHER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 W HOLLY AVE
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-2913
Mailing Address - Country:US
Mailing Address - Phone:310-748-6104
Mailing Address - Fax:
Practice Address - Street 1:153 S DOHENY DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2509
Practice Address - Country:US
Practice Address - Phone:310-888-8896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF03230588363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily