Provider Demographics
NPI:1891055117
Name:NDUAGUBA, REBECCA J (DO)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:J
Last Name:NDUAGUBA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PERKINS SQ
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-1063
Mailing Address - Country:US
Mailing Address - Phone:419-522-3341
Mailing Address - Fax:
Practice Address - Street 1:1029 S TRIMBLE RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-3427
Practice Address - Country:US
Practice Address - Phone:419-522-3341
Practice Address - Fax:419-522-1110
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390200000X
OH34011659208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program