Healthcare Provider Details

I. General information

NPI: 1932662079
Provider Name (Legal Business Name): REBECCA CHERYL KOENIGSBERG DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2019
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7514 E MONTEREY WAY STE 1
SCOTTSDALE AZ
85251-6900
US

IV. Provider business mailing address

7514 E MONTEREY WAY STE 1
SCOTTSDALE AZ
85251-6900
US

V. Phone/Fax

Practice location:
  • Phone: 480-949-7377
  • Fax: 480-949-8339
Mailing address:
  • Phone: 480-614-8011
  • Fax: 480-949-8339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number34.015769
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number010971
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: