Healthcare Provider Details

I. General information

NPI: 1134695612
Provider Name (Legal Business Name): RACHEL BUZBEE LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL KEYOHARA

II. Dates (important events)

Enumeration Date: 10/22/2018
Last Update Date: 10/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3625 RUFFIN RD STE 302
SAN DIEGO CA
92123-1832
US

IV. Provider business mailing address

2981 WOODBURY CT
CARLSBAD CA
92010-6544
US

V. Phone/Fax

Practice location:
  • Phone: 619-884-0601
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number108951
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: