Healthcare Provider Details

I. General information

NPI: 1356893135
Provider Name (Legal Business Name): JESSICA LILLIAN ZOVAR M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2016
Last Update Date: 08/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 41ST AVE
SANTA CRUZ CA
95062-5208
US

IV. Provider business mailing address

PO BOX 1870
WATSONVILLE CA
95077-1870
US

V. Phone/Fax

Practice location:
  • Phone: 310-428-8689
  • Fax:
Mailing address:
  • Phone: 831-728-0222
  • Fax: 831-707-2777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT111742
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: