1801027495 NPI number — TANIA DAVIDSON PSYD A PSYCHOLOGICAL CORPORATION

Table of content: (NPI 1801027495)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801027495 NPI number — TANIA DAVIDSON PSYD A PSYCHOLOGICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TANIA DAVIDSON PSYD A PSYCHOLOGICAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801027495
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/26/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1198 NAVIGATOR DR # 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VENTURA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93001-4334
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-320-5256
Provider Business Mailing Address Fax Number:
805-339-0806

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 TAMAL PLZ STE 130
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORTE MADERA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94925-1195
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-347-3438
Provider Business Practice Location Address Fax Number:
805-339-0806
Provider Enumeration Date:
07/31/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DAVIDSON
Authorized Official First Name:
TANIA
Authorized Official Middle Name:
Authorized Official Title or Position:
PSYCHOLOGIST
Authorized Official Telephone Number:
415-347-3438

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PSY16510 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)