Provider Demographics
NPI:1457717118
Name:TANIKA ROSS
Entity Type:Organization
Organization Name:TANIKA ROSS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASTER'S SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:TANIKA
Authorized Official - Middle Name:JIMATA
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:ASW
Authorized Official - Phone:707-514-9412
Mailing Address - Street 1:1106 ARAQUIPA CT
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-6571
Mailing Address - Country:US
Mailing Address - Phone:707-514-9412
Mailing Address - Fax:
Practice Address - Street 1:1106 ARAQUIPA CT
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-6571
Practice Address - Country:US
Practice Address - Phone:707-514-9412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========Medicaid