Provider Demographics
NPI:1689002404
Name:REZA, REBECCA (MSN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:REZA
Suffix:
Gender:F
Credentials:MSN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7165 E UNIVERSITY DR STE 154
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-6412
Mailing Address - Country:US
Mailing Address - Phone:480-818-9150
Mailing Address - Fax:623-738-3182
Practice Address - Street 1:4121 E VALLEY AUTO DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4631
Practice Address - Country:US
Practice Address - Phone:602-285-9696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-15
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ299129363LP0808X
AZ161388163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WS0200XNursing Service ProvidersRegistered NurseSchool