Provider Demographics
NPI:1952969560
Name:ADAMI, REBECCA JEAN
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JEAN
Last Name:ADAMI
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 1:901 PARADISE CREEK RD # 1702
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-1900
Mailing Address - Country:US
Mailing Address - Phone:925-470-7141
Mailing Address - Fax:
Practice Address - Street 1:2949 HONEYSUCKLE CIR
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-6329
Practice Address - Country:US
Practice Address - Phone:925-470-7141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer