Provider Demographics
NPI:1225682867
Name:ST JEAN, TIANA K
Entity Type:Individual
Prefix:
First Name:TIANA
Middle Name:K
Last Name:ST JEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TIANA
Other - Middle Name:K
Other - Last Name:PHOSRITHONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4228 LOYALTON RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568
Mailing Address - Country:US
Mailing Address - Phone:415-335-8257
Mailing Address - Fax:
Practice Address - Street 1:4228 LOYALTON RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568
Practice Address - Country:US
Practice Address - Phone:415-335-8257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician