Provider Demographics
NPI:1891088704
Name:TARANTINO, TARA LAUREN (DO)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:LAUREN
Last Name:TARANTINO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:LAUREN
Other - Last Name:SCHLEIFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2255 YGNACIO VALLEY RD SUITE V
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2168
Mailing Address - Country:US
Mailing Address - Phone:925-448-2610
Mailing Address - Fax:925-448-2611
Practice Address - Street 1:2255 YGNACIO VALLEY RD SUITE V
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598
Practice Address - Country:US
Practice Address - Phone:925-448-2610
Practice Address - Fax:925-448-2611
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2023-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A13976207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine