MEDICARE: JANET ANN RUSTIGAN LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	80851	CA

General Provider Information

NPI Number	:	1912285594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET ANN RUSTIGAN LMFT

Provider Business Mailing Address
First Line	:	8316 FRANZ VALLEY RD
Second Line	:
City	:	CALISTOGA
State	:	CA
Zip	:	94515-9550
Country	:	US
Telephone Number	:	707-326-8849
Fax Number	:

Provider Business Practice Location Address
First Line	:	659 CHERRY ST STE 203
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95404-4281
Country	:	US
Telephone Number	:	707-326-8849
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2011
Last Update Date	:	08/06/2019

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