Healthcare Provider Details

I. General information

NPI: 1073448429
Provider Name (Legal Business Name): MARIANA TISCARENO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15651 IMPERIAL HWY STE 207
LA MIRADA CA
90638-1653
US

IV. Provider business mailing address

16122 SHADY VALLEY LN
WHITTIER CA
90603-2632
US

V. Phone/Fax

Practice location:
  • Phone: 562-262-6808
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number161705
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: