Healthcare Provider Details

I. General information

NPI: 1073447645
Provider Name (Legal Business Name): MARY HANNA TADROS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5671 42ND ST
JURUPA VALLEY CA
92509-6679
US

IV. Provider business mailing address

13503 POINTER CT
RIVERSIDE CA
92503-7327
US

V. Phone/Fax

Practice location:
  • Phone: 951-360-4100
  • Fax:
Mailing address:
  • Phone: 951-360-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number26587
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: