Healthcare Provider Details

I. General information

NPI: 1801078829
Provider Name (Legal Business Name): REBECCA A PORRATA PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2007
Last Update Date: 11/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 6TH ST
POINT REYES STATION CA
94956
US

IV. Provider business mailing address

899 NORTHGATE STE 100
SAN RAFAEL CA
94903
US

V. Phone/Fax

Practice location:
  • Phone: 415-663-8231
  • Fax: 415-473-3828
Mailing address:
  • Phone: 415-473-3809
  • Fax: 415-473-3828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number254662
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: