Provider Demographics
NPI:1881392926
Name:TRIEBOLD, REBECCA ANNE (PA-C)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:ANNE
Last Name:TRIEBOLD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:ANNE
Other - Last Name:PIECHUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:333 H ST STE 2000
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-5556
Mailing Address - Country:US
Mailing Address - Phone:619-427-0665
Mailing Address - Fax:
Practice Address - Street 1:333 H ST STE 2000
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-5556
Practice Address - Country:US
Practice Address - Phone:619-427-0665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-17
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA62275207Q00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine