Provider Demographics
NPI:1891435095
Name:TINGLEY, TATIANA ISABEL
Entity Type:Individual
Prefix:
First Name:TATIANA
Middle Name:ISABEL
Last Name:TINGLEY
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 1:710 S BROADWAY STE 250
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5234
Mailing Address - Country:US
Mailing Address - Phone:925-968-8648
Mailing Address - Fax:
Practice Address - Street 1:710 S BROADWAY STE 250
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5234
Practice Address - Country:US
Practice Address - Phone:925-968-8648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF8048158OtherDRIVER LICENSE