Healthcare Provider Details

I. General information

NPI: 1770498735
Provider Name (Legal Business Name): ROB RUTKOWSKI LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2026
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19712 MACARTHUR BLVD STE 110
IRVINE CA
92612-2407
US

IV. Provider business mailing address

26791 ALISO CREEK RD # 1084
ALISO VIEJO CA
92656-2887
US

V. Phone/Fax

Practice location:
  • Phone: 949-371-9419
  • Fax:
Mailing address:
  • Phone: 949-371-9419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number163932
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: