Basic Information
| Provider Information | |||||||||
| NPI: | 1841572682 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RADOMSKI | ||||||||
| FirstName: | REBEKAH | ||||||||
| MiddleName: | ERIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 MAREBLU | ||||||||
| Address2: | |||||||||
| City: | ALISO VIEJO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926563014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9496436901 | ||||||||
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| Practice Location | |||||||||
| Address1: | 405 W 5TH ST | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927014599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7147969126 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2011 | ||||||||
| LastUpdateDate: | 06/27/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.