Healthcare Provider Details

I. General information

NPI: 1174026959
Provider Name (Legal Business Name): REBECCA LYNNE SURREY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2018
Last Update Date: 12/01/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 Y ST STE 2500
SACRAMENTO CA
95817-2307
US

IV. Provider business mailing address

4860 Y ST STE 2500
SACRAMENTO CA
95817-2307
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-6978
  • Fax: 916-734-6666
Mailing address:
  • Phone: 916-734-6978
  • Fax: 916-734-6666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberA164473
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberA164473
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: