Healthcare Provider Details

I. General information

NPI: 1982926705
Provider Name (Legal Business Name): REBECCA A COELHO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2010
Last Update Date: 12/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1829 SILVANA LN
SANTA CRUZ CA
95062-3060
US

IV. Provider business mailing address

1829 SILVANA LN
SANTA CRUZ CA
95062-3060
US

V. Phone/Fax

Practice location:
  • Phone: 831-464-2961
  • Fax: 831-464-8678
Mailing address:
  • Phone: 831-464-2961
  • Fax: 831-464-8678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: