Healthcare Provider Details

I. General information

NPI: 1922823624
Provider Name (Legal Business Name): TANISHA MICHEL CADAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12890 QUINTA WAY
DESERT HOT SPRINGS CA
92240-4852
US

IV. Provider business mailing address

12890 QUINTA WAY
DESERT HOT SPRINGS CA
92240-4852
US

V. Phone/Fax

Practice location:
  • Phone: 760-329-2959
  • Fax:
Mailing address:
  • Phone: 760-329-2959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCI50990426
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: