Provider Demographics
NPI:1164111555
Name:LAFUENTE, TANIA MICHELLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:MICHELLE
Last Name:LAFUENTE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:TANIA
Other - Middle Name:MICHELLE
Other - Last Name:BARANOV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25751 EMMERSON ST
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3911
Mailing Address - Country:US
Mailing Address - Phone:909-649-3879
Mailing Address - Fax:
Practice Address - Street 1:3883 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-2204
Practice Address - Country:US
Practice Address - Phone:626-351-0589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87380183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist