Provider Demographics
NPI:1649066960
Name:RAWLS, TATIANNA-BRINAY K
Entity type:Individual
Prefix:
First Name:TATIANNA-BRINAY
Middle Name:K
Last Name:RAWLS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3039 RANDALL WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94541-5540
Mailing Address - Country:US
Mailing Address - Phone:510-512-6391
Mailing Address - Fax:
Practice Address - Street 1:605 STANDIFORD AVE STE 10
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-1000
Practice Address - Country:US
Practice Address - Phone:209-452-8996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician