Provider Demographics
NPI:1497088249
Name:ANVAR, TARA DAWNIEL (BA)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:DAWNIEL
Last Name:ANVAR
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 ALICANTE
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-3807
Mailing Address - Country:US
Mailing Address - Phone:949-215-8454
Mailing Address - Fax:
Practice Address - Street 1:28 ALICANTE
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-3807
Practice Address - Country:US
Practice Address - Phone:949-215-8454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-11
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker