Healthcare Provider Details

I. General information

NPI: 1790183804
Provider Name (Legal Business Name): CASSANDRA KRISTINA ROVETTI MS, RDN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2014
Last Update Date: 12/24/2024
Certification Date: 12/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 N C ST
TUSTIN CA
92780-3222
US

IV. Provider business mailing address

175 N C ST
TUSTIN CA
92780-3222
US

V. Phone/Fax

Practice location:
  • Phone: 909-709-9402
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1070105
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: