Provider Demographics
NPI:1346801719
Name:SMALL, REBECCA CHEN (NP)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:CHEN
Last Name:SMALL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 WOODWARD ST APT A
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2403
Mailing Address - Country:US
Mailing Address - Phone:415-298-9987
Mailing Address - Fax:
Practice Address - Street 1:1357 OAKLAND CT
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4337
Practice Address - Country:US
Practice Address - Phone:925-935-3010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95200885163WH0200X
172V00000X
CA95018772363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No172V00000XOther Service ProvidersCommunity Health Worker