Provider Demographics
NPI:1598928343
Name:VERRETT-EARL, TAJUAN N
Entity Type:Individual
Prefix:MRS
First Name:TAJUAN
Middle Name:N
Last Name:VERRETT-EARL
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TAJUAN
Other - Middle Name:N
Other - Last Name:VERRETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:572 N ARROWHEAD AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92401-1251
Mailing Address - Country:US
Mailing Address - Phone:909-266-2700
Mailing Address - Fax:909-266-2791
Practice Address - Street 1:572 N ARROWHEAD AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92401-1251
Practice Address - Country:US
Practice Address - Phone:909-266-2700
Practice Address - Fax:909-266-2791
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator