Healthcare Provider Details

I. General information

NPI: 1083100275
Provider Name (Legal Business Name): TATIANA ARACELY DONAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2018
Last Update Date: 09/22/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44000 OLD WARM SPRINGS BLVD
FREMONT CA
94538-6145
US

IV. Provider business mailing address

44000 OLD WARM SPRINGS BLVD
FREMONT CA
94538-6145
US

V. Phone/Fax

Practice location:
  • Phone: 213-241-3841
  • Fax: 213-241-3305
Mailing address:
  • Phone: 510-897-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: