Healthcare Provider Details

I. General information

NPI: 1457724684
Provider Name (Legal Business Name): MRS. REBECCA BARNES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2015
Last Update Date: 12/10/2023
Certification Date: 12/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PRISON RD
REPRESA CA
95671-7567
US

IV. Provider business mailing address

7806 UPLANDS WAY
CITRUS HEIGHTS CA
95610-7567
US

V. Phone/Fax

Practice location:
  • Phone: 916-985-8610
  • Fax:
Mailing address:
  • Phone: 916-967-6253
  • Fax: 916-965-3992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number93381
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: