Provider Demographics
NPI:1972854487
Name:TARAZANA TREATMENT CENTER
Entity Type:Organization
Organization Name:TARAZANA TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FSP CASE MANGER
Authorized Official - Prefix:MS
Authorized Official - First Name:XOCHILL
Authorized Official - Middle Name:
Authorized Official - Last Name:AZMITIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-996-1051
Mailing Address - Street 1:6646 HAZELTINE AVE
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-4754
Mailing Address - Country:US
Mailing Address - Phone:818-808-5703
Mailing Address - Fax:
Practice Address - Street 1:18646 OXNARD ST
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-1411
Practice Address - Country:US
Practice Address - Phone:818-996-1051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD6078636347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle