Provider Demographics
NPI:1114686003
Name:TAPIA, NAOMI
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:TAPIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17240 OLIVE ST.
Mailing Address - Street 2:P.O. BOX #4000584
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92340
Mailing Address - Country:US
Mailing Address - Phone:442-354-1736
Mailing Address - Fax:
Practice Address - Street 1:17268 MANZANITA ST
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-1862
Practice Address - Country:US
Practice Address - Phone:442-354-1736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA128232101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health