Provider Demographics
NPI:1609159615
Name:WARE, REBECCA RM (PA - C)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:RM
Last Name:WARE
Suffix:
Gender:F
Credentials:PA - C
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:R
Other - Last Name:MERCADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA- C
Mailing Address - Street 1:255 TERRACINA BLVD.
Mailing Address - Street 2:SUITE 101A
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373
Mailing Address - Country:US
Mailing Address - Phone:909-748-6569
Mailing Address - Fax:
Practice Address - Street 1:255 TERRACINA BLVD.
Practice Address - Street 2:SUITE 101A
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373
Practice Address - Country:US
Practice Address - Phone:909-748-6569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21890363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant