Provider Demographics
NPI:1588800361
Name:LANE, REBECCA S (MD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:S
Last Name:LANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:S
Other - Last Name:NELKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:15539 WOODCREST DR
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-4228
Mailing Address - Country:US
Mailing Address - Phone:310-652-0100
Mailing Address - Fax:
Practice Address - Street 1:1301 20TH ST FL 4
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2050
Practice Address - Country:US
Practice Address - Phone:310-652-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-27
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79176207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACC001AMedicare PIN