Healthcare Provider Details

I. General information

NPI: 1881189264
Provider Name (Legal Business Name): FELICIA TARA TAING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12141 BROOKHURST ST
GARDEN GROVE CA
92840-2865
US

IV. Provider business mailing address

12141 BROOKHURST ST
GARDEN GROVE CA
92840-2865
US

V. Phone/Fax

Practice location:
  • Phone: 714-296-1934
  • Fax:
Mailing address:
  • Phone: 714-296-1934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number92627
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number111926
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: