Healthcare Provider Details

I. General information

NPI: 1982173134
Provider Name (Legal Business Name): ALYSSA DAWN REHART
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2018
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10390 COLOMA RD STE A
RANCHO CORDOVA CA
95670-2152
US

IV. Provider business mailing address

10390 COLOMA RD STE A
RANCHO CORDOVA CA
95670-2152
US

V. Phone/Fax

Practice location:
  • Phone: 916-214-2976
  • Fax:
Mailing address:
  • Phone: 916-214-2976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-69390
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: