Provider Demographics
NPI:1730972084
Name:CHITTENDEN, REBECCA BLYTHE (RRA, RT(R))
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:BLYTHE
Last Name:CHITTENDEN
Suffix:
Gender:F
Credentials:RRA, RT(R)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1827 E 4TH ST APT 10
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-3810
Mailing Address - Country:US
Mailing Address - Phone:315-420-3443
Mailing Address - Fax:
Practice Address - Street 1:6440 SOUTH ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90713-1713
Practice Address - Country:US
Practice Address - Phone:562-627-0903
Practice Address - Fax:562-627-0923
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHF115985156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156F00000XEye and Vision Services ProvidersTechnician/TechnologistGroup - Single Specialty