Healthcare Provider Details

I. General information

NPI: 1235352139
Provider Name (Legal Business Name): REBECCA L DWYER CONAHAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 09/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 2ND ST
ENCINITAS CA
92024-3507
US

IV. Provider business mailing address

PO BOX 235432
ENCINITAS CA
92023-5432
US

V. Phone/Fax

Practice location:
  • Phone: 760-753-7842
  • Fax:
Mailing address:
  • Phone: 310-318-4485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA89066
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number244924
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: