Healthcare Provider Details

I. General information

NPI: 1235477712
Provider Name (Legal Business Name): REBECCA ELIZABETH ROVETO MFTI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2013
Last Update Date: 10/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 SOQUEL AVE STE 203
SANTA CRUZ CA
95062-2328
US

IV. Provider business mailing address

340 SOQUEL AVE STE 203
SANTA CRUZ CA
95062-2328
US

V. Phone/Fax

Practice location:
  • Phone: 831-239-3660
  • Fax:
Mailing address:
  • Phone: 831-239-3660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFTI#73684
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT90190
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: