Provider Demographics
NPI:1164954434
Name:KEITH, REBECCA RAY (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:RAY
Last Name:KEITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1260 15TH ST STE 1501
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1150
Practice Address - Country:US
Practice Address - Phone:310-656-1701
Practice Address - Fax:310-451-0931
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA169277207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA169277OtherMEDICAL LICENSE
CAA169277OtherMEDICAL LICENSE