Provider Demographics
NPI:1376881334
Name:RAYA-FERNANDEZ, REBECCA DANA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:DANA
Last Name:RAYA-FERNANDEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7171 N MILLBROOK AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3363
Mailing Address - Country:US
Mailing Address - Phone:559-439-2776
Mailing Address - Fax:
Practice Address - Street 1:7171 N MILLBROOK AVE STE 102
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3363
Practice Address - Country:US
Practice Address - Phone:559-439-2776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-26
Last Update Date:2013-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23325103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical