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General NPI Number Information
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NPI Number | 1710840491
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Entity Type | Individual
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Provider Name | MRS. REBECCA LEE FALLEN
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Gender | Female
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Dates
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Enumeration Date | 12/08/2025
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 15200 FOOTHILL BLVD
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City | CASTRO VALLEY
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State | CA
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Zip | 94578-1013
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Country | US
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Telephone | 510-764-4060
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Fax |
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Provider Business Mailing Address
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Address Line | 22 SINGLE OAKS DR
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City | SHERWOOD
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State | AR
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Zip | 72120-1545
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Country | US
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Telephone | 501-733-7290
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WA2000X
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Taxonomy Name | Administrator Registered Nurse
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License Number | 95430313
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License Number State | CA
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