Provider Demographics
NPI:1790183804
Name:ROVETTI, CASSANDRA KRISTINA (MS, RDN, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:KRISTINA
Last Name:ROVETTI
Suffix:
Gender:F
Credentials:MS, RDN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 N C ST
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3222
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:175 N C ST
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3222
Practice Address - Country:US
Practice Address - Phone:909-709-9402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-05
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1070105133V00000X
174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered