Provider Demographics
NPI:1689131377
Name:TAN, JEANNEL AUREA ENRIQUEZ MARINAS
Entity Type:Individual
Prefix:MRS
First Name:JEANNEL AUREA
Middle Name:ENRIQUEZ MARINAS
Last Name:TAN
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 1:19061 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-2559
Mailing Address - Country:US
Mailing Address - Phone:510-610-0727
Mailing Address - Fax:
Practice Address - Street 1:19061 MADISON AVE
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-2559
Practice Address - Country:US
Practice Address - Phone:510-610-0727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist