Healthcare Provider Details

I. General information

NPI: 1710804364
Provider Name (Legal Business Name): R & R FAMILY THERAPY PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10717 SAINT JAMES AVE
SOUTH GATE CA
90280-7109
US

IV. Provider business mailing address

PO BOX 829
SOUTH GATE CA
90280-8829
US

V. Phone/Fax

Practice location:
  • Phone: 323-696-1889
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: ROSARIO TABARES
Title or Position: OWNER
Credential: LMFT
Phone: 310-945-7086