Provider Demographics
NPI:1134567928
Name:BROKER, REBEKAH CARTER (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:REBEKAH
Middle Name:CARTER
Last Name:BROKER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-4033
Mailing Address - Country:US
Mailing Address - Phone:310-429-5754
Mailing Address - Fax:
Practice Address - Street 1:1218 HARPER AVE
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-4033
Practice Address - Country:US
Practice Address - Phone:310-429-5754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12101174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist