Healthcare Provider Details

I. General information

NPI: 1710106703
Provider Name (Legal Business Name): REBECCA ANN STAUFFER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HARPST ST HUMBOLDT STATE UNIVERSITY
ARCATA CA
95521-8222
US

IV. Provider business mailing address

1 HARPST ST HUMBOLDT STATE UNIVERSITY
ARCATA CA
95521-8222
US

V. Phone/Fax

Practice location:
  • Phone: 707-826-5029
  • Fax: 707-826-5042
Mailing address:
  • Phone: 707-826-5029
  • Fax: 707-826-5042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG50694
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: