Provider Demographics
NPI:1932297793
Name:LACEY-BEBE, KATHLEEN REGINA (NP)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:REGINA
Last Name:LACEY-BEBE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:129 N BROADWAY UNIT D
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3170
Mailing Address - Country:US
Mailing Address - Phone:310-489-7490
Mailing Address - Fax:
Practice Address - Street 1:3440 LOMITA BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4801
Practice Address - Country:US
Practice Address - Phone:310-325-8864
Practice Address - Fax:310-325-1493
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7341363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health