MEDICARE: ELSIE RUBY TOVAR

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	62071 MFTINTERN	CA

General Provider Information

NPI Number	:	1962780130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELSIE RUBY TOVAR

Provider Business Mailing Address
First Line	:	PO BOX 711832
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92171-1832
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1012 C ST
Second Line	:	YWCA OF SAN DIEGO
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-5522
Country	:	US
Telephone Number	:	619-239-0355
Fax Number	:	619-233-8545

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

Provider Enumeration Date	:	07/21/2011
Last Update Date	:	07/21/2011

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