Provider Demographics
NPI:1770585606
Name:KERR, REBECCA (MD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:KERR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8610 S SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-4008
Mailing Address - Country:US
Mailing Address - Phone:310-642-7900
Mailing Address - Fax:310-642-7903
Practice Address - Street 1:8610 S SEPULVEDA BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-4012
Practice Address - Country:US
Practice Address - Phone:310-642-7900
Practice Address - Fax:310-642-7903
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG51583208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG51583AMedicare PIN
CAP00963799Medicare PIN
CAA93085Medicare UPIN