Healthcare Provider Details

I. General information

NPI: 1033049721
Provider Name (Legal Business Name): TANYA R MARK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 BLUE OAKS BLVD STE 260
ROSEVILLE CA
95747-4003
US

IV. Provider business mailing address

3665 SNOWCAP VIEW CIR APT 4
AUBURN CA
95602-2179
US

V. Phone/Fax

Practice location:
  • Phone: 530-887-1006
  • Fax:
Mailing address:
  • Phone: 916-287-5870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: