Provider Demographics
NPI:1336640796
Name:HATCHETT, TANYA TABADA TAGAY
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:TABADA TAGAY
Last Name:HATCHETT
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 1:3340 WALNUT AVE STE 290
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2215
Mailing Address - Country:US
Mailing Address - Phone:510-698-2896
Mailing Address - Fax:
Practice Address - Street 1:3340 WALNUT AVE STE 290
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2215
Practice Address - Country:US
Practice Address - Phone:510-698-2896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician