Healthcare Provider Details

I. General information

NPI: 1275482382
Provider Name (Legal Business Name): TANIA ROBUCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2026
Last Update Date: 01/23/2026
Certification Date: 01/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 ERTEN ST
THOUSAND OAKS CA
91360-1810
US

IV. Provider business mailing address

94 WILDLIFE DR
SIMI VALLEY CA
93065-5376
US

V. Phone/Fax

Practice location:
  • Phone: 310-775-5776
  • Fax:
Mailing address:
  • Phone: 310-775-5776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: