Provider Demographics
NPI:1346941507
Name:CEDRO, REBECCA D
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:D
Last Name:CEDRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10722 ARROW RTE STE 814A
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4843
Mailing Address - Country:US
Mailing Address - Phone:909-527-4690
Mailing Address - Fax:909-527-3352
Practice Address - Street 1:10722 ARROW RTE STE 814A
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4843
Practice Address - Country:US
Practice Address - Phone:909-527-4690
Practice Address - Fax:909-527-3352
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95024095363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily