Healthcare Provider Details

I. General information

NPI: 1497448740
Provider Name (Legal Business Name): REBECCA TZARNOTZKY M.A. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REBECCA REGOS M.A. CCC-SLP

II. Dates (important events)

Enumeration Date: 06/01/2023
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 PIPPIN DR
SUNNYVALE CA
94087-1151
US

IV. Provider business mailing address

888 PIPPIN DR
SUNNYVALE CA
94087-1151
US

V. Phone/Fax

Practice location:
  • Phone: 650-353-0176
  • Fax:
Mailing address:
  • Phone: 650-353-0176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number19804
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: