Healthcare Provider Details

I. General information

NPI: 1689134850
Provider Name (Legal Business Name): TANIA ELIZABETH CORONA ORANTES MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9844 RESEARCH DR
IRVINE CA
92618-4381
US

IV. Provider business mailing address

PO BOX 231831
ENCINITAS CA
92023-1831
US

V. Phone/Fax

Practice location:
  • Phone: 760-815-9968
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number12151826
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: