Provider Demographics
NPI:1306367982
Name:BOENING, REBECCA REID (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:REID
Last Name:BOENING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:REID
Other - Last Name:FILBRANDT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:263 N VILLA AVE
Mailing Address - Street 2:
Mailing Address - City:WILLOWS
Mailing Address - State:CA
Mailing Address - Zip Code:95988-2607
Mailing Address - Country:US
Mailing Address - Phone:530-934-8700
Mailing Address - Fax:530-934-3011
Practice Address - Street 1:263 N VILLA AVE
Practice Address - Street 2:
Practice Address - City:WILLOWS
Practice Address - State:CA
Practice Address - Zip Code:95988-2607
Practice Address - Country:US
Practice Address - Phone:530-934-8700
Practice Address - Fax:530-934-3011
Is Sole Proprietor?:No
Enumeration Date:2017-07-04
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA163710208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1306367982Medicaid