Provider Demographics
NPI:1851558696
Name:PREDILETTO, REBECCA LYNN TIDWELL (CNM)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN TIDWELL
Last Name:PREDILETTO
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2489 LOY LN
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-1817
Mailing Address - Country:US
Mailing Address - Phone:213-923-4042
Mailing Address - Fax:
Practice Address - Street 1:1416 EL CENTRO ST
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-3202
Practice Address - Country:US
Practice Address - Phone:626-577-2229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA222176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife