Provider Demographics
NPI:1023765377
Name:ARMSTRONG, REBECCA ROISMAN (PA)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ROISMAN
Last Name:ARMSTRONG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:ANNA
Other - Last Name:ROISMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1144 65TH ST STE F
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94608-1053
Mailing Address - Country:US
Mailing Address - Phone:510-929-1400
Mailing Address - Fax:510-929-1414
Practice Address - Street 1:1144 65TH ST STE F
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94608-1053
Practice Address - Country:US
Practice Address - Phone:510-929-1400
Practice Address - Fax:510-929-1414
Is Sole Proprietor?:No
Enumeration Date:2022-03-07
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60786363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant