Healthcare Provider Details

I. General information

NPI: 1023295748
Provider Name (Legal Business Name): PENELOPE RAYAS MFT TRAINEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2008
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 EMELINE AVE
SANTA CRUZ CA
95060-1976
US

IV. Provider business mailing address

1400 EMELINE AVE
SANTA CRUZ CA
95060-1976
US

V. Phone/Fax

Practice location:
  • Phone: 831-454-4965
  • Fax: 831-454-4916
Mailing address:
  • Phone: 831-454-4965
  • Fax: 831-454-4916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT49734
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: