Provider Demographics
NPI:1992221782
Name:TO, REBECCA (MED)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:TO
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 KAUAULA RD
Mailing Address - Street 2:
Mailing Address - City:LAHAINA
Mailing Address - State:HI
Mailing Address - Zip Code:96761-1150
Mailing Address - Country:US
Mailing Address - Phone:808-392-0530
Mailing Address - Fax:
Practice Address - Street 1:69 KAUAULA RD
Practice Address - Street 2:
Practice Address - City:LAHAINA
Practice Address - State:HI
Practice Address - Zip Code:96761-1150
Practice Address - Country:US
Practice Address - Phone:808-392-0530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-14
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician