Provider Demographics
NPI:1376383828
Name:ALMADIN, TATYANA SHANAE (MA, ATC)
Entity type:Individual
Prefix:
First Name:TATYANA
Middle Name:SHANAE
Last Name:ALMADIN
Suffix:
Gender:F
Credentials:MA, ATC
Other - Prefix:MRS
Other - First Name:TATYANA
Other - Middle Name:SHANAE
Other - Last Name:ALMADIN-ROSAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, ATC
Mailing Address - Street 1:11295 LOS OSOS VALLEY RD APT 23
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-6349
Mailing Address - Country:US
Mailing Address - Phone:805-714-6717
Mailing Address - Fax:
Practice Address - Street 1:1 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93407-9000
Practice Address - Country:US
Practice Address - Phone:805-756-5491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20000386842255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer