Healthcare Provider Details

I. General information

NPI: 1346879517
Provider Name (Legal Business Name): ROBERT PLAVAJKA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2677 N MAIN ST STE 130
SANTA ANA CA
92705-6665
US

IV. Provider business mailing address

19510 VAN BUREN BLVD # F3-1027
RIVERSIDE CA
92508-9457
US

V. Phone/Fax

Practice location:
  • Phone: 800-801-9833
  • Fax:
Mailing address:
  • Phone: 951-323-9464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number131336
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: