Provider Demographics
NPI:1407954829
Name:MIDDLETON, REBECCA MARIE
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:MARIE
Last Name:MIDDLETON
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 1:1736 GROUSE RUN CIR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-4921
Mailing Address - Country:US
Mailing Address - Phone:916-524-1945
Mailing Address - Fax:
Practice Address - Street 1:8080 MADISON AVE
Practice Address - Street 2:SUITE 204A
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-3759
Practice Address - Country:US
Practice Address - Phone:916-524-1945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist