Provider Demographics
NPI:1447914544
Name:OLIVER ROMAN, REBECCA G (PHD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:G
Last Name:OLIVER ROMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19762 MACARTHUR BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2425
Mailing Address - Country:US
Mailing Address - Phone:424-201-1600
Mailing Address - Fax:
Practice Address - Street 1:19762 MACARTHUR BLVD STE 120
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-2425
Practice Address - Country:US
Practice Address - Phone:424-201-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-25
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY33005103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical