Provider Demographics
NPI:1184737348
Name:CLYDE, REBECCA MARIE (MD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARIE
Last Name:CLYDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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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:510-204-8090
Mailing Address - Fax:510-506-7726
Practice Address - Street 1:2970 HILLTOP MALL RD STE 304
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94806-5274
Practice Address - Country:US
Practice Address - Phone:510-204-8090
Practice Address - Fax:510-506-7726
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA71193207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA71193OtherSTATE MEDICAL LICENSE
CAA71193OtherSTATE MEDICAL LICENSE