Provider Demographics
NPI:1457741886
Name:TADROUS-FURNANZ, SANDY
Entity type:Individual
Prefix:MRS
First Name:SANDY
Middle Name:
Last Name:TADROUS-FURNANZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SANDY
Other - Middle Name:
Other - Last Name:TADROUS-FURNANZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:670 N HILL AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-1248
Mailing Address - Country:US
Mailing Address - Phone:562-413-6434
Mailing Address - Fax:
Practice Address - Street 1:10315 NW TANASBOURNE DRIVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124
Practice Address - Country:US
Practice Address - Phone:971-291-6761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PSB94021117390200000X
CAPSB94021117101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program