Provider Demographics
NPI:1518054477
Name:HETHUMUNI, REHANA MINOLI (DO)
Entity Type:Individual
Prefix:MS
First Name:REHANA
Middle Name:MINOLI
Last Name:HETHUMUNI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:101 E. BEVERLY BLVD, SUITE 404
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640
Mailing Address - Country:US
Mailing Address - Phone:626-676-6038
Mailing Address - Fax:323-722-0158
Practice Address - Street 1:101 E. BEVERLY BLVD, SUITE 404
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640
Practice Address - Country:US
Practice Address - Phone:626-676-6038
Practice Address - Fax:323-722-0158
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8993207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine