Provider Demographics
NPI:1790461226
Name:LUNDEEN, REBECCA J (EDD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:J
Last Name:LUNDEEN
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4102 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-1783
Mailing Address - Country:US
Mailing Address - Phone:714-475-9286
Mailing Address - Fax:
Practice Address - Street 1:4102 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-1783
Practice Address - Country:US
Practice Address - Phone:714-475-9286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-27
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA220115915103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool