Provider Demographics
NPI:1679832166
Name:ROVAY-HAZELTON, REBECCA A (CN, CMTA, FDN)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:A
Last Name:ROVAY-HAZELTON
Suffix:
Gender:F
Credentials:CN, CMTA, FDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 LEE ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-1914
Mailing Address - Country:US
Mailing Address - Phone:831-461-1600
Mailing Address - Fax:
Practice Address - Street 1:337 LEE ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-1914
Practice Address - Country:US
Practice Address - Phone:831-461-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA001059133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist