Provider Demographics
NPI:1588214316
Name:TANCHANCO, MARIA THERESE PATRIC R
Entity Type:Individual
Prefix:
First Name:MARIA THERESE PATRIC
Middle Name:R
Last Name:TANCHANCO
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 1:101 W AMERICAN CANYON RD STE 508
Mailing Address - Street 2:
Mailing Address - City:AMERICAN CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:94503-1163
Mailing Address - Country:US
Mailing Address - Phone:510-426-6165
Mailing Address - Fax:
Practice Address - Street 1:1559B SLOAT BLVD #240
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132
Practice Address - Country:US
Practice Address - Phone:510-629-0889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-13
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA115493106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist