Provider Demographics
NPI:1417069691
Name:REBANAL, PERLITA M (NP MSN)
Entity Type:Individual
Prefix:MRS
First Name:PERLITA
Middle Name:M
Last Name:REBANAL
Suffix:
Gender:F
Credentials:NP MSN
Other - Prefix:MRS
Other - First Name:PERLITA
Other - Middle Name:M
Other - Last Name:REBANAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN,NP
Mailing Address - Street 1:11262 GRAYRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-5518
Mailing Address - Country:US
Mailing Address - Phone:310-268-3530
Mailing Address - Fax:310-268-4653
Practice Address - Street 1:11301 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90073-1003
Practice Address - Country:US
Practice Address - Phone:310-268-3530
Practice Address - Fax:310-268-4653
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA185810163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA36OtherNURSEPRACTITIONER