Basic Information
| Provider Information | |||||||||
| NPI: | 1477884948 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EVERT | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | RUTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 127 ANNED DR | ||||||||
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| City: | PLACENTIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928705635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7147328357 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2990 INLAND EMPIRE BLVD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | ONTARIO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917644899 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099803427 | ||||||||
| FaxNumber: | 9099453426 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2010 | ||||||||
| LastUpdateDate: | 02/10/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225400000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner |
No ID Information.