MEDICARE: RACHEL DITTMAR

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	390200000X	Student in an Organized Health Care Education/Training Program
2	106H00000X	Marriage & Family Therapist	115165	CA

General Provider Information

NPI Number	:	1790104453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL DITTMAR

Provider Business Mailing Address
First Line	:	119 FIGUEROA ST STE 12
Second Line	:
City	:	VENTURA
State	:	CA
Zip	:	93001-2756
Country	:	US
Telephone Number	:	760-453-0284
Fax Number	:

Provider Business Practice Location Address
First Line	:	1002 E GRAND AVE
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92025-4605
Country	:	US
Telephone Number	:	619-591-5740
Fax Number	:

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

Provider Enumeration Date	:	04/09/2014
Last Update Date	:	03/24/2026

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