Provider Demographics
NPI:1639637101
Name:TANARE, ROWENA ROSE
Entity Type:Individual
Prefix:
First Name:ROWENA
Middle Name:ROSE
Last Name:TANARE
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 1:3605 E RAMON RD
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92264-1150
Mailing Address - Country:US
Mailing Address - Phone:760-325-5630
Mailing Address - Fax:760-325-5668
Practice Address - Street 1:2500 N PALM CANYON DR
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-1868
Practice Address - Country:US
Practice Address - Phone:760-904-4957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-04
Last Update Date:2023-01-20
Deactivation Date:2022-12-02
Deactivation Code:
Reactivation Date:2023-01-04
Provider Licenses
StateLicense IDTaxonomies
247200000X, 390200000X
CAACSW1107461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program