Provider Demographics
NPI:1821359969
Name:ROJAS, TATIANA KATHLEEN
Entity type:Individual
Prefix:
First Name:TATIANA
Middle Name:KATHLEEN
Last Name:ROJAS
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 1:10155 COLIMA RD
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-2042
Mailing Address - Country:US
Mailing Address - Phone:562-457-7644
Mailing Address - Fax:
Practice Address - Street 1:4736 N VINCENT AVE APT C
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91722-2359
Practice Address - Country:US
Practice Address - Phone:562-457-7644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT105526106H00000X
CAMFTI 75832101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7368OtherMEDI-CAL
CA7667OtherMEDI-CAL
CA7708OtherMEDI-CAL
CA7184OtherMEDI-CAL