MEDICARE: MRS. JESSICA LILLIAN ZOVAR M.A.

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
1	106H00000X	Marriage & Family Therapist	LMFT111742	CA

General Provider Information

NPI Number	:	1356893135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA LILLIAN ZOVAR M.A.

Provider Business Mailing Address
First Line	:	PO BOX 1870
Second Line	:
City	:	WATSONVILLE
State	:	CA
Zip	:	95077-1870
Country	:	US
Telephone Number	:	831-728-0222
Fax Number	:	831-707-2777

Provider Business Practice Location Address
First Line	:	711 41ST AVE
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95062-5208
Country	:	US
Telephone Number	:	310-428-8689
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2016
Last Update Date	:	08/21/2019

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