Healthcare Provider Details

I. General information

NPI: 1013101500
Provider Name (Legal Business Name): REBECCA ANNE STARK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 07/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 STOCKTON BLVD UCDMC GLASSROCK PEDS. SURGERY - SUITE 3200
SACRAMENTO CA
95817-2207
US

IV. Provider business mailing address

2221 STOCKTON BLVD UCDMC CYPRESS BLDG., 3RD FLOOR
SACRAMENTO CA
95817-1418
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-3229
  • Fax:
Mailing address:
  • Phone: 916-734-3229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberA109860
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: