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NPI Code Detail

MEDICARE: DR. REGINA H RUSHE PH.D.

MEDICARE: DR. REGINA H RUSHE PH.D.
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
1103TC0700XClinical Psychologist17602CA

General Provider Information

NPI Number : 1205046463
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. REGINA H RUSHE PH.D.
Provider Business Mailing Address
First Line : 5905 LAKE EARL DR
Second Line :
City : CRESCENT CITY
State : CA
Zip : 95532-0001
Country : US
Telephone Number : 707-465-1000
Fax Number : 707-465-9107
Provider Business Practice Location Address
First Line : 5905 LAKE EARL DR
Second Line :
City : CRESCENT CITY
State : CA
Zip : 95532-0001
Country : US
Telephone Number : 707-465-1000
Fax Number : 707-465-9107
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2007
Last Update Date : 07/08/2007

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