Healthcare Provider Details

I. General information

NPI: 1336976695
Provider Name (Legal Business Name): TASHANA BEDNAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2024
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73255 EL PASEO STE 18
PALM DESERT CA
92260-4249
US

IV. Provider business mailing address

34868 MISSION HILLS DR
RANCHO MIRAGE CA
92270-1320
US

V. Phone/Fax

Practice location:
  • Phone: 760-385-3959
  • Fax: 760-406-5621
Mailing address:
  • Phone: 760-408-6497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number144534
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: