Basic Information
| Provider Information | |||||||||
| NPI: | 1548205115 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FAITH | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | N. | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSN, NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 350 30TH ST STE 320 | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946093425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104656700 | ||||||||
| FaxNumber: | 5104657765 | ||||||||
| Practice Location | |||||||||
| Address1: | 350 30TH ST STE 320 | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946093425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104656700 | ||||||||
| FaxNumber: | 5104657765 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2006 | ||||||||
| LastUpdateDate: | 08/03/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 570909 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 005709090 | 05 | CA | MEDICAID |