Healthcare Provider Details

I. General information

NPI: 1831761899
Provider Name (Legal Business Name): TANYA VICTORIA BOSQUE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TANYA VICTORIA RAMIREZ LCSW

II. Dates (important events)

Enumeration Date: 07/10/2021
Last Update Date: 07/10/2021
Certification Date: 07/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 E 4TH ST
NATIONAL CITY CA
91950-2026
US

IV. Provider business mailing address

PO BOX 713052
SANTEE CA
92072-3052
US

V. Phone/Fax

Practice location:
  • Phone: 619-470-4321
  • Fax:
Mailing address:
  • Phone: 562-822-3403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number87800
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: