Healthcare Provider Details

I. General information

NPI: 1528989936
Provider Name (Legal Business Name): ELIZABETH RAVE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W TWN CNTRY RD STE 1250
ORANGE CA
92868-4633
US

IV. Provider business mailing address

32 BLOOMDALE
IRVINE CA
92614-7531
US

V. Phone/Fax

Practice location:
  • Phone: 877-397-2630
  • Fax:
Mailing address:
  • Phone: 310-626-5809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: