Provider Demographics
NPI:1255660668
Name:HABANSKY, REBECCA (ND)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:HABANSKY
Suffix:
Gender:F
Credentials:ND
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:H
Other - Last Name:PORRINO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ND
Mailing Address - Street 1:710 W NAPA ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-6408
Mailing Address - Country:US
Mailing Address - Phone:707-996-9355
Mailing Address - Fax:
Practice Address - Street 1:710 W NAPA ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-6408
Practice Address - Country:US
Practice Address - Phone:707-996-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA--294175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath