Healthcare Provider Details

I. General information

NPI: 1285519660
Provider Name (Legal Business Name): TANIA ISABEL CARDENAS ZEPEDA MSW,ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TANIA ZEPEDA

II. Dates (important events)

Enumeration Date: 08/06/2025
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 H ST
MODESTO CA
95354-2338
US

IV. Provider business mailing address

1100 H ST
MODESTO CA
95354-2338
US

V. Phone/Fax

Practice location:
  • Phone: 209-238-6632
  • Fax:
Mailing address:
  • Phone: 209-238-6632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number105003
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: