Healthcare Provider Details

I. General information

NPI: 1760310452
Provider Name (Legal Business Name): ANTHONY REBELO M.A., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 MEMORIAL DR
WEAVERVILLE CA
96093
US

IV. Provider business mailing address

PO BOX 1256
WEAVERVILLE CA
96093-1256
US

V. Phone/Fax

Practice location:
  • Phone: 530-623-2861
  • Fax:
Mailing address:
  • Phone: 530-623-2861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: