Provider Demographics
NPI:1558920595
Name:VITTONE, TARA RENEE
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:RENEE
Last Name:VITTONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:RENEE
Other - Last Name:HARP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:137 N COTTONWOOD ST STE 1500
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-6646
Mailing Address - Country:US
Mailing Address - Phone:530-419-9470
Mailing Address - Fax:
Practice Address - Street 1:137 N COTTONWOOD ST STE 1500
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-6646
Practice Address - Country:US
Practice Address - Phone:530-419-9470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator