Healthcare Provider Details

I. General information

NPI: 1245150853
Provider Name (Legal Business Name): TATIANA TANAI MOJICA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2666 STATE ST
HAMDEN CT
06517-2232
US

IV. Provider business mailing address

467 COLUMBUS AVE APT 2E
NEW HAVEN CT
06519-1246
US

V. Phone/Fax

Practice location:
  • Phone: 888-754-0398
  • Fax:
Mailing address:
  • Phone: 203-909-5593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: