DR. REBECCA MARDACH (NPI# 1457330607) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457330607 |
| Entity Type | Individual |
| Full Name | DR. REBECCA MARDACH |
| Other Name | DR. REBECCA MARDACH-VERDON |
| Credential | MD |
| Practice Address |
3030 Childrens Way San Diego CA 92123 |
| Mailing Address |
3020 Childrens Way # Mc5003 San Diego CA 92123-4223 |
| Practice Telephone | 6195437800 |
| Mailing Telephone | 8583096300 |
| Enumeration Date | 2006-01-14 |
| Last Update Date | 2019-06-03 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207SG0201X |
Medical Genetics Specialization: Clinical Genetics (M.D.) |
A45110 | CA | Allopathic & Osteopathic Physicians |
| N | 207SG0202X |
Medical Genetics Specialization: Clinical Biochemical Genetics |
A45110 | CA | Allopathic & Osteopathic Physicians |
| N | 208000000X | Pediatrics | A45110 | CA | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 4700 W Sunset Blvd, First Floor, Los Angeles, CA 900276082 | 3237836970 | 3237836915 |
| 7920 Frost St Ste 200, San Diego, CA 921234289 | 8589665840 |
| Street Address |
3030 CHILDRENS WAY |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92123 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144229600 | Charles Douglas Wallace | Orthopaedic Surgery | 3030 Childrens Way, Ste 410, San Diego, CA 92123-4232 | 2005-07-18 |
| 1841808854 | Lorri A. Kais | Clinical Neuropsychologist | 3030 Childrens Way, San Diego, CA 92123-4232 | 2020-07-15 |
| 1114541760 | Samantha Barbara Nigrelli | Nurse Practitioner | 3030 Childrens Way, San Diego, CA 92123-4232 | 2020-05-29 |
| 1134755630 | Sara J. Fligelman | Psychologist | 3030 Childrens Way, San Diego, CA 92123-4232 | 2020-03-16 |
| 1316571367 | Kayleigh M. Prowse | Nurse Practitioner | 3030 Childrens Way, San Diego, CA 92123-4232 | 2020-02-28 |
| 1639649239 | Kimberly Charlotte Padilla | Nurse Practitioner | 3030 Childrens Way, San Diego, CA 92123 | 2018-11-27 |
| 1568953172 | Elizabeth Williams Smith | Nurse Practitioner | 3030 Childrens Way, San Diego, CA 92123-4232 | 2018-05-21 |
| 1083132260 | Eve U. Nguyen | Psychologist | 3030 Childrens Way, San Diego, CA 92123-4232 | 2017-09-07 |
| 1659893295 | Ronak Rahmanian | Otolaryngology | 3030 Childrens Way, San Diego, CA 92123-4232 | 2017-07-14 |
| 1689048530 | Carie Truong Lam | Physician Assistant | 3030 Childrens Way, San Diego, CA 92123-4232 | 2015-11-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669087326 | Corina Lozano Manzo | Registered Nurse | 7436 Mission Center Road, San Diego, CA 92123 | 2020-09-10 |
| 1831703537 | Shannon Leigh Doolittle | Audiologist | 3020 Children's Way Mc5010, San Diego, CA 92123 | 2020-09-01 |
| 1861014359 | Ha Thanh Truong | Pharmacist | Rezcare, 3821 Calle Fortunada, San Diego, CA 92123 | 2020-05-07 |
| 1023667136 | Brittany Meyer | Physical Therapist | 3020 Children's Waymc5068, San Diego, CA 92123 | 2019-09-11 |
| 1598313272 | Ryan Edward Shaw | Marriage & Family Therapist | 8910 Clairmont Mesa Blvd, San Diego, CA 92123 | 2019-08-27 |
| 1528611910 | Tanisha C Fulcher | Marriage & Family Therapist | 8825 Aero Dr., Ste 315, San Diago, CA 92123 | 2019-07-24 |
| 1245795665 | Robin James Pekin | Marriage & Family Therapist | 4450 Kearny Villa Rd, #116, San Diego, CA 92123 | 2019-02-11 |
| 1174093728 | Karen Vences | Counselor | 8755 Aero Dr Suite 230, San Diego, CA 92123 | 2018-11-27 |
| 1255808465 | Natasha Herrera | Counselor | 2801 Meadow Lark Dr, San Diego, San Diego, CA 92123 | 2018-10-25 |
| 1407321987 | Maneka Elikewela | Behavior Technician | 3934 Murphy Canyon Rd, Ste B202, San Diego, CA 92123 | 2018-10-10 |
| Find all providers in zip 92123 | ||||
| Taxonomy Code | 207SG0201X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Medical Genetics |
| Specialization | Clinical Genetics (M.D.) |
| A clinical geneticist demonstrates competence in providing comprehensive diagnostic, management and counseling services for genetic disorders. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Medical Genetics, 2007. http://www.abmg.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Medical Genetics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740238104 | Keith Kenneth Vaux | Medical Genetics | 2790 Truxtun Rd Ste 120a, San Diego, CA 92106-6135 | 2006-05-05 |
| 1629040605 | Allan T Bombard | Medical Genetics | 3003 Health Center Dr, San Diego, CA 92123 | 2006-02-03 |
| 1598141475 | Miguel Del Campo Casanelles | Medical Genetics | 7920 Frost St, Ste 200, San Diego, CA 92123-2736 | 2015-08-03 |
| 1487920724 | Kristen Michelle Wigby | Medical Genetics | 7920 Frost St Ste 200, San Diego, CA 92123 | 2012-03-30 |
| 1275796419 | David P. Dimmock | Medical Genetics | 3030 Childrens Way, San Diego, CA 92123-4232 | 2008-07-08 |
| 1497941397 | Anna-kaisa Niemi | Medical Genetics | 3020 Childrens Way, San Diego, CA 92123 | 2007-09-25 |
| 1154493476 | Fred Levine | Medical Genetics | 7910 Frost St, Ste 200, San Diego, CA 92123-2771 | 2006-11-14 |
| 1487725230 | Lynne Marie Bird | Medical Genetics | 7920 Frost St, Ste 200, San Diego, CA 92123-2736 | 2006-11-13 |
| 1295806040 | Marilyn Crandall Jones | Medical Genetics | 7920 Frost St, Ste 200, San Diego, CA 92123-2736 | 2006-11-13 |
| 1487744330 | Albert Russell La Spada | Medical Genetics | 7920 Frost St, Ste 200, San Diego, CA 92123-2736 | 2006-10-13 |
| Find all providers in SAN DIEGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.