Healthcare Provider Details

I. General information

NPI: 1194311464
Provider Name (Legal Business Name): TANYA DANTUS MA, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2020
Last Update Date: 07/21/2022
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BURGACKERWEG 10B
FREIBURG BADEN-WRTTEMBERG
79104
DE

IV. Provider business mailing address

4908 LADERA SARINA
DEL MAR CA
92014-4230
US

V. Phone/Fax

Practice location:
  • Phone: 858-480-7685
  • Fax: 573-368-0067
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number120399
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: