Healthcare Provider Details

I. General information

NPI: 1336394790
Provider Name (Legal Business Name): TANI MAYEDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2008
Last Update Date: 11/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 S H ST
BAKERSFIELD CA
93304-5602
US

IV. Provider business mailing address

407 COVEY AVE APT. B
BAKERSFIELD CA
93308-4283
US

V. Phone/Fax

Practice location:
  • Phone: 661-398-4303
  • Fax: 661-398-4306
Mailing address:
  • Phone: 661-477-8260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: