Healthcare Provider Details

I. General information

NPI: 1639859820
Provider Name (Legal Business Name): REBECCA DIANA SMITH PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2023
Last Update Date: 07/21/2023
Certification Date: 07/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 HOPYARD RD STE 202
PLEASANTON CA
94588-8528
US

IV. Provider business mailing address

10231 CORFU DR
ELK GROVE CA
95624-9681
US

V. Phone/Fax

Practice location:
  • Phone: 925-847-5051
  • Fax:
Mailing address:
  • Phone: 916-834-1375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY34331
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: