Provider Demographics
NPI:1457023954
Name:MATTHEWS, REBECCA DIANE
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:DIANE
Last Name:MATTHEWS
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 1:11502 BLUE GRASS DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-5412
Mailing Address - Country:US
Mailing Address - Phone:661-404-2448
Mailing Address - Fax:
Practice Address - Street 1:6401 WHITE LN STE 107
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-7786
Practice Address - Country:US
Practice Address - Phone:661-404-2448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-02
Last Update Date:2021-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty