Provider Demographics
NPI:1780138594
Name:CHAIREZ, TANYA
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:CHAIREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24268 DOLAN DR
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-3322
Mailing Address - Country:US
Mailing Address - Phone:951-640-4136
Mailing Address - Fax:
Practice Address - Street 1:612 S MYRTLE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-3406
Practice Address - Country:US
Practice Address - Phone:562-400-6865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst