Provider Demographics
NPI:1629833652
Name:JOSIMOV, TANJA
Entity type:Individual
Prefix:
First Name:TANJA
Middle Name:
Last Name:JOSIMOV
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 1:624 N TOLUCA PARK DR APT C
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-3145
Mailing Address - Country:US
Mailing Address - Phone:949-672-8795
Mailing Address - Fax:
Practice Address - Street 1:9696 CULVER BLVD
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-2700
Practice Address - Country:US
Practice Address - Phone:213-674-1882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2025-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health