Healthcare Provider Details

I. General information

NPI: 1356822951
Provider Name (Legal Business Name): REBECCA RICHMOND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2018
Last Update Date: 04/06/2024
Certification Date: 04/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2755 ALAMO ST STE 201
SIMI VALLEY CA
93065-1311
US

IV. Provider business mailing address

4368 CEDARMEADOW CT
MOORPARK CA
93021-2740
US

V. Phone/Fax

Practice location:
  • Phone: 805-578-9620
  • Fax: 805-583-1937
Mailing address:
  • Phone: 641-831-0436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA117656
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95009783
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: