Provider Demographics
NPI:1710945340
Name:KORNBLUH, REBECCA A (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:A
Last Name:KORNBLUH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:232 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-4323
Mailing Address - Country:US
Mailing Address - Phone:909-244-2195
Mailing Address - Fax:
Practice Address - Street 1:158 GENTRY ST
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-2100
Practice Address - Country:US
Practice Address - Phone:909-244-2195
Practice Address - Fax:909-425-6635
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1593422084P0800X
CAA798442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry