Healthcare Provider Details

I. General information

NPI: 1750213104
Provider Name (Legal Business Name): ABBY RUTH WITHROW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

125 BETHANY DR
SANTA CRUZ CA
95066-2803
US

IV. Provider business mailing address

700 FREDERICK ST
SANTA CRUZ CA
95062-2239
US

V. Phone/Fax

Practice location:
  • Phone: 844-322-7483
  • Fax:
Mailing address:
  • Phone: 844-322-7483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number106S00000X
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: