Provider Demographics
NPI:1619311453
Name:TAUB, REBECCA L (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:L
Last Name:TAUB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:510-204-5600
Mailing Address - Fax:510-506-7722
Practice Address - Street 1:2500 MILVIA ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704
Practice Address - Country:US
Practice Address - Phone:510-204-5600
Practice Address - Fax:510-506-7722
Is Sole Proprietor?:No
Enumeration Date:2013-04-23
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA162980207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8966606OtherMEDICARE PIN
CAA162980OtherSTATE MEDICAL LICENSE