Healthcare Provider Details

I. General information

NPI: 1659851186
Provider Name (Legal Business Name): ROXANNA MCCABE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2018
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date: 03/11/2021
Reactivation Date: 12/20/2024

III. Provider practice location address

6305 RITA AVENUE
HUNTINGTON PARK CA
90255
US

IV. Provider business mailing address

6305 RITA AVENUE
HUNTINGTON PARK CA
90255
US

V. Phone/Fax

Practice location:
  • Phone: 323-205-5679
  • Fax:
Mailing address:
  • Phone: 323-205-5679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number131548
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: