Provider Demographics
NPI:1316023468
Name:DOROCAK, TANYA CORNWELL (MA)
Entity Type:Individual
Prefix:MS
First Name:TANYA
Middle Name:CORNWELL
Last Name:DOROCAK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2012
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92018-2012
Mailing Address - Country:US
Mailing Address - Phone:858-279-1223
Mailing Address - Fax:760-597-4880
Practice Address - Street 1:2120 THIBODO COURT
Practice Address - Street 2:SUITE 230
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081
Practice Address - Country:US
Practice Address - Phone:858-279-1223
Practice Address - Fax:760-597-4880
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC42652106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist