Provider Demographics
NPI:1780569608
Name:ISLAS, REBECCA (PPS)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:ISLAS
Suffix:
Gender:F
Credentials:PPS
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:REZEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PPS
Mailing Address - Street 1:35972 SUSAN ST
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-6300
Mailing Address - Country:US
Mailing Address - Phone:909-790-8521
Mailing Address - Fax:
Practice Address - Street 1:35972 SUSAN ST
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-6300
Practice Address - Country:US
Practice Address - Phone:909-790-8521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool