Healthcare Provider Details

I. General information

NPI: 1831486778
Provider Name (Legal Business Name): REBECCA (NASTASSIA) E. RISER M.S., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NASTASSIA REBECCA RISER M.S., PH.D.

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 10/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 GARDEN VIEW CT STE 201J
ENCINITAS CA
92024-2479
US

IV. Provider business mailing address

700 GARDEN VIEW CT STE 201J
ENCINITAS CA
92024-2479
US

V. Phone/Fax

Practice location:
  • Phone: 760-492-9057
  • Fax:
Mailing address:
  • Phone: 760-492-9057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number30973
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: