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General NPI Number Information
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NPI Number | 1821806472
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Entity Type | Individual
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Provider Name | TANIA DAFNE MANDUJANO AMFT
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Gender | Female
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Dates
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Enumeration Date | 12/27/2024
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 808 W 58TH ST
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City | LOS ANGELES
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State | CA
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Zip | 90037-3632
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Country | US
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Telephone | 323-541-1411
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Fax |
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Provider Business Mailing Address
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Address Line | 11431 GALE AVE APT 6
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City | HAWTHORNE
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State | CA
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Zip | 90250-2189
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Country | US
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Telephone | 310-957-1359
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | AMFT151287
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License Number State | CA
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