Provider Demographics
NPI:1831350529
Name:SHODA-MEYER, REBECCA (PSYD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:SHODA-MEYER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 E FRUIT ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-4459
Mailing Address - Country:US
Mailing Address - Phone:714-396-0837
Mailing Address - Fax:714-541-8256
Practice Address - Street 1:2220 E FRUIT ST
Practice Address - Street 2:SUITE 109
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-4459
Practice Address - Country:US
Practice Address - Phone:714-396-0837
Practice Address - Fax:714-541-8256
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22019103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAR997OtherMEDICARE