Provider Demographics
NPI:1952126963
Name:CONSUNJI, REBECCA MAE
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:MAE
Last Name:CONSUNJI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74250 GOLETA AVE
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-3061
Mailing Address - Country:US
Mailing Address - Phone:562-607-8650
Mailing Address - Fax:
Practice Address - Street 1:74250 GOLETA AVE
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-3061
Practice Address - Country:US
Practice Address - Phone:562-607-8650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst