MEDICARE: REBECCA GAINES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor

General Provider Information

NPI Number	:	1730489550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA GAINES

Provider Business Mailing Address
First Line	:	1755 BLUE BONNET CIR APT 3204
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75040-5342
Country	:	US
Telephone Number	:	682-500-9725
Fax Number	:

Provider Business Practice Location Address
First Line	:	1755 BLUE BONNET CIR APT 3204
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75040-5342
Country	:	US
Telephone Number	:	682-500-9725
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2010
Last Update Date	:	07/21/2022

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Directions to “ REBECCA GAINES ” Practice Location

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