Healthcare Provider Details

I. General information

NPI: 1053058198
Provider Name (Legal Business Name): REBEKAH L MACKAMUL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2022
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 E HOSPITALITY LN STE 400
SAN BERNARDINO CA
92408-3545
US

IV. Provider business mailing address

27720 20TH ST
HIGHLAND CA
92346-2617
US

V. Phone/Fax

Practice location:
  • Phone: 909-891-1599
  • Fax:
Mailing address:
  • Phone: 909-965-8687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: