Healthcare Provider Details

I. General information

NPI: 1568083590
Provider Name (Legal Business Name): REBECCA SUE FRISBY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2020
Last Update Date: 04/30/2020
Certification Date: 04/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10985 STINNETT MILL RD
SALADO TX
76571-6469
US

IV. Provider business mailing address

10985 STINNETT MILL RD
SALADO TX
76571-6469
US

V. Phone/Fax

Practice location:
  • Phone: 510-364-8475
  • Fax:
Mailing address:
  • Phone: 510-364-8475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number468422
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: