Provider Demographics
NPI:1104539048
Name:RAPAN, TATYANA
Entity type:Individual
Prefix:
First Name:TATYANA
Middle Name:
Last Name:RAPAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21600 OXNARD ST STE 1030
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-5085
Mailing Address - Country:US
Mailing Address - Phone:442-320-3369
Mailing Address - Fax:
Practice Address - Street 1:91050 7TH ST APT 502
Practice Address - Street 2:
Practice Address - City:MECCA
Practice Address - State:CA
Practice Address - Zip Code:92254-6528
Practice Address - Country:US
Practice Address - Phone:442-320-3369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician