Healthcare Provider Details

I. General information

NPI: 1083369169
Provider Name (Legal Business Name): REBEKAH VACA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2022
Last Update Date: 02/17/2022
Certification Date: 02/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 W ARROW HWY
SAN DIMAS CA
91773-2969
US

IV. Provider business mailing address

416 N 12TH ST
MONTEBELLO CA
90640-4106
US

V. Phone/Fax

Practice location:
  • Phone: 909-592-2778
  • Fax: 909-592-2789
Mailing address:
  • Phone: 323-787-0325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT301712
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: