Provider Demographics
NPI:1396409975
Name:DAVIS, TANIA
Entity Type:Individual
Prefix:MRS
First Name:TANIA
Middle Name:
Last Name:DAVIS
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 1:444 GEORGIA ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-6005
Mailing Address - Country:US
Mailing Address - Phone:707-703-5132
Mailing Address - Fax:
Practice Address - Street 1:444 GEORGIA ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-6005
Practice Address - Country:US
Practice Address - Phone:707-703-5132
Practice Address - Fax:707-638-0398
Is Sole Proprietor?:No
Enumeration Date:2021-10-28
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA104100000X, 104100000X, 225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner