Provider Demographics
NPI:1073773818
Name:ARMENDARIZ, REBECCA T (MD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:T
Last Name:ARMENDARIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10010 CAMPUS POINT DR # DRIVE210
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1518
Mailing Address - Country:US
Mailing Address - Phone:619-992-6577
Mailing Address - Fax:
Practice Address - Street 1:4805 NE GLISAN ST STE 11N
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2933
Practice Address - Country:US
Practice Address - Phone:503-215-1350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD187653207PH0002X
CAC175874207PH0002X, 2081H0002X, 207RH0002X
AZ479342081H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207PH0002XAllopathic & Osteopathic PhysiciansEmergency MedicineHospice and Palliative Medicine
No2081H0002XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ835234Medicaid
AZ835234Medicaid
AZZ196092Medicare PIN