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NPI Code Detail

MEDICARE: RUBY JO CVETAN-ROSS LMFT

MEDICARE:   RUBY JO CVETAN-ROSS  LMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistMFT 24861CA

General Provider Information

NPI Number : 1306132956
Entity Type Code : Individual
Provider Name (Legal Business Name) : RUBY JO CVETAN-ROSS LMFT
Provider Business Mailing Address
First Line : 53 BAYSHORE CIR
Second Line :
City : SAN BRUNO
State : CA
Zip : 94066-1505
Country : US
Telephone Number : 650-871-0477
Fax Number :
Provider Business Practice Location Address
First Line : 3789 HOOVER ST
Second Line :
City : REDWOOD CITY
State : CA
Zip : 94063-4504
Country : US
Telephone Number : 650-363-8735
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2011
Last Update Date : 06/22/2011

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Directions to “ RUBY JO CVETAN-ROSS LMFT” Practice Location

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