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NPI Code Detail

MEDICARE: REBECCA S MODGLIN

MEDICARE: REBECCA S MODGLIN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TS0200XSchool Psychologist

General Provider Information

NPI Number : 1063399293
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA S MODGLIN
Provider Business Mailing Address
First Line : 5297 MAUREEN LN
Second Line :
City : MOORPARK
State : CA
Zip : 93021-7125
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5297 MAUREEN LN
Second Line :
City : MOORPARK
State : CA
Zip : 93021-7125
Country : US
Telephone Number : 805-378-6306
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2025
Last Update Date : 08/19/2025

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Directions to “ REBECCA S MODGLIN ” Practice Location

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