Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 52028 | MA |
NPI | 1023139193 |
---|---|
Provider Name | Rebekka Taratuta |
First Address | Brookline, MA 02446-5244 |
Second Address | Hathorne, MA 01937 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 24/02/2014 |