Healthcare Provider Details

I. General information

NPI: 1316852148
Provider Name (Legal Business Name): ELISABETH RAVE DIPIETRO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7040 WELLS FARGO WAY
CORNING CA
96021-9009
US

IV. Provider business mailing address

7040 WELLS FARGO WAY
CORNING CA
96021-9009
US

V. Phone/Fax

Practice location:
  • Phone: 530-765-3776
  • Fax:
Mailing address:
  • Phone: 530-765-3776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: