Healthcare Provider Details

I. General information

NPI: 1679680623
Provider Name (Legal Business Name): REBECCA L WEBB MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA LYNN SORENSON MD

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 LOS LENTES RD SE STE 3
LOS LUNAS NM
87031-6018
US

IV. Provider business mailing address

PO BOX 28164
SANTA FE NM
87592-8164
US

V. Phone/Fax

Practice location:
  • Phone: 505-865-3350
  • Fax:
Mailing address:
  • Phone: 505-216-2727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number29533
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number38265
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036121318
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD2010-0009
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: