Healthcare Provider Details

I. General information

NPI: 1104220474
Provider Name (Legal Business Name): MRS. REBECCA SIQUEIROS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2014
Last Update Date: 10/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 RACE ST
SAN JOSE CA
95126-4823
US

IV. Provider business mailing address

237 RACE ST
SAN JOSE CA
95126-4823
US

V. Phone/Fax

Practice location:
  • Phone: 408-510-3480
  • Fax:
Mailing address:
  • Phone: 408-510-3480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: