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 1:15814 WINCHESTER BLVD STE 105
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-3333
Practice Address - Country:US
Practice Address - Phone:408-872-8796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health