Healthcare Provider Details

I. General information

NPI: 1144132184
Provider Name (Legal Business Name): REBECCA GREEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27555 YNEZ RD
TEMECULA CA
92591-4687
US

IV. Provider business mailing address

16510 ANTELOPE ST
LAKE ELSINORE CA
92530-1769
US

V. Phone/Fax

Practice location:
  • Phone: 951-694-0100
  • Fax: 907-770-0862
Mailing address:
  • Phone: 951-409-4989
  • Fax: 907-770-0862

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: