Provider Demographics
NPI:1487112371
Name:PAK, REBECCA ANN (CPNP-PC)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ANN
Last Name:PAK
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27800 MEDICAL CENTER RD STE 204
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6408
Mailing Address - Country:US
Mailing Address - Phone:949-364-3532
Mailing Address - Fax:949-347-7645
Practice Address - Street 1:27800 MEDICAL CENTER RD STE 204
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6408
Practice Address - Country:US
Practice Address - Phone:949-364-3532
Practice Address - Fax:949-347-7645
Is Sole Proprietor?:No
Enumeration Date:2019-03-09
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010977363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty