Healthcare Provider Details

I. General information

NPI: 1962323345
Provider Name (Legal Business Name): REBECCA EMERITA GEDDES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32219 INDIAN GUIDE RD
SQUAW VALLEY CA
93675-9307
US

IV. Provider business mailing address

32219 INDIAN GUIDE RD
SQUAW VALLEY CA
93675-9307
US

V. Phone/Fax

Practice location:
  • Phone: 626-354-9077
  • Fax: 626-354-9077
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: