Healthcare Provider Details

I. General information

NPI: 1356878953
Provider Name (Legal Business Name): REBECCA MARIE INNES DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2017
Last Update Date: 08/23/2025
Certification Date: 08/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 E TANGERINE RD STE 201
ORO VALLEY AZ
85755-6218
US

IV. Provider business mailing address

1521 E TANGERINE RD STE 201
ORO VALLEY AZ
85755-6218
US

V. Phone/Fax

Practice location:
  • Phone: 520-901-3500
  • Fax:
Mailing address:
  • Phone: 520-605-5664
  • Fax: 520-605-5665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number009795
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number5101023049
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: