Healthcare Provider Details

I. General information

NPI: 1508424599
Provider Name (Legal Business Name): REBECCA Z WU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9343 TECH CENTER DR
SACRAMENTO CA
95826-2563
US

IV. Provider business mailing address

9343 TECH CENTER DR STE 200
SACRAMENTO CA
95826-2592
US

V. Phone/Fax

Practice location:
  • Phone: 913-388-6400
  • Fax:
Mailing address:
  • Phone: 916-388-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number142141
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: