Provider Demographics
NPI:1851734388
Name:DESLOOVER, TANYA SARKISIAN
Entity Type:Individual
Prefix:MISS
First Name:TANYA
Middle Name:SARKISIAN
Last Name:DESLOOVER
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 1:8132 FORELLE DR APT 3
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-1698
Mailing Address - Country:US
Mailing Address - Phone:949-514-9154
Mailing Address - Fax:
Practice Address - Street 1:2800 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3753
Practice Address - Country:US
Practice Address - Phone:949-514-9145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC48574106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist