MEDICARE: MRS. REBECCA MARIA WHITFIELD CSFA

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	246ZC0007X	Surgical Assistant	209577

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	26023397	OTHER	TX	DRIVER LICENCSE

General Provider Information

NPI Number	:	1750028700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REBECCA MARIA WHITFIELD CSFA

Provider Business Mailing Address
First Line	:	7777 FOREST LN STE
Second Line	:	SUITE B216
City	:	DALLAS
State	:	TX
Zip	:	75230-6810
Country	:	US
Telephone Number	:	214-613-1589
Fax Number	:

Provider Business Practice Location Address
First Line	:	7777 FOREST LN STE B216
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-6810
Country	:	US
Telephone Number	:	214-613-1589
Fax Number	:

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

Provider Enumeration Date	:	05/19/2022
Last Update Date	:	05/19/2022

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