Healthcare Provider Details

I. General information

NPI: 1326269127
Provider Name (Legal Business Name): REBECCA JEAN CHESTER R.D.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4540 KEARNY VILLA RD SUITE 116
SAN DIEGO CA
92123-1571
US

IV. Provider business mailing address

2409 FELSPAR ST
SAN DIEGO CA
92109-3708
US

V. Phone/Fax

Practice location:
  • Phone: 858-571-3534
  • Fax: 858-571-5826
Mailing address:
  • Phone: 858-483-8834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number21071
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: