Healthcare Provider Details

I. General information

NPI: 1386618023
Provider Name (Legal Business Name): REBECCA SMALL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 BAY AVE STE A
CAPITOLA CA
95010-2173
US

IV. Provider business mailing address

830 BAY AVE STE A
CAPITOLA CA
95010-2173
US

V. Phone/Fax

Practice location:
  • Phone: 831-422-7777
  • Fax: 831-649-4961
Mailing address:
  • Phone: 831-649-1000
  • Fax: 831-649-4961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA73250
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: