Healthcare Provider Details

I. General information

NPI: 1770104184
Provider Name (Legal Business Name): JILLANDRA ROVARIS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2020
Last Update Date: 04/27/2020
Certification Date: 04/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 EL CAMINO REAL
SANTA CLARA CA
95050-4345
US

IV. Provider business mailing address

500 EL CAMINO REAL
SANTA CLARA CA
95050-4345
US

V. Phone/Fax

Practice location:
  • Phone: 408-554-4501
  • Fax:
Mailing address:
  • Phone: 408-554-4501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY25526
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: