Healthcare Provider Details

I. General information

NPI: 1861081606
Provider Name (Legal Business Name): REBEKAH BARBARA JOYCE ENSLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2021
Last Update Date: 01/15/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2984 FLETCHER PKWY APT D
EL CAJON CA
92020-2642
US

IV. Provider business mailing address

2984 FLETCHER PKWY APT D
EL CAJON CA
92020-2642
US

V. Phone/Fax

Practice location:
  • Phone: 281-825-6088
  • Fax:
Mailing address:
  • Phone: 281-825-6088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: