Healthcare Provider Details

I. General information

NPI: 1629628730
Provider Name (Legal Business Name): HANNAH ROVAZZINI LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4510 EXECUTIVE DRIVE
SAN DIEGO CA
92121
US

IV. Provider business mailing address

1125 SANTA HELENA PARK COURT
SOLANA BEACH CA
92075
US

V. Phone/Fax

Practice location:
  • Phone: 858-221-0344
  • Fax:
Mailing address:
  • Phone: 858-449-8986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number109021
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: