Provider Demographics
NPI:1811695026
Name:NUDEL, REBECCA SILLS
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:SILLS
Last Name:NUDEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 E AVENIDA DE LOS ARBOLES # 156
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-1361
Mailing Address - Country:US
Mailing Address - Phone:310-386-4339
Mailing Address - Fax:
Practice Address - Street 1:28494 WESTINGHOUSE PL STE 206
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-0933
Practice Address - Country:US
Practice Address - Phone:661-903-8822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA137024106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist