Healthcare Provider Details

I. General information

NPI: 1215395181
Provider Name (Legal Business Name): REBECCA MEYER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2016
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 N CARPENTER RD STE C19
MODESTO CA
95351-1156
US

IV. Provider business mailing address

1620 N CARPENTER RD STE C19
MODESTO CA
95351-1156
US

V. Phone/Fax

Practice location:
  • Phone: 209-900-3722
  • Fax: 209-545-1648
Mailing address:
  • Phone: 209-900-3722
  • Fax: 209-545-1468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-15-19358
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: