Provider Demographics
NPI:1912635640
Name:TOMMASINO, NATALIE A
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:A
Last Name:TOMMASINO
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 1:3400 STEVENSON BLVD APT U34
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-5853
Mailing Address - Country:US
Mailing Address - Phone:858-692-6853
Mailing Address - Fax:
Practice Address - Street 1:36901 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-2719
Practice Address - Country:US
Practice Address - Phone:510-818-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101200000X, 171M00000X, 390200000X
CA146308106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101200000XBehavioral Health & Social Service ProvidersDrama Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program