Provider Demographics
NPI:1275656878
Name:STONE, REBECCA L (LMT)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:L
Last Name:STONE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2916 PASAJE DEL HERRERO
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-6529
Mailing Address - Country:US
Mailing Address - Phone:505-820-2988
Mailing Address - Fax:
Practice Address - Street 1:2916 PASAJE DEL HERRERO
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-6529
Practice Address - Country:US
Practice Address - Phone:505-690-2624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2945174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist