Provider Demographics
NPI:1427378546
Name:ENGEL, TINA ELAINE
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:ELAINE
Last Name:ENGEL
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 1:1420 SAN TOMAS AQUINO RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95130-1131
Mailing Address - Country:US
Mailing Address - Phone:916-838-9878
Mailing Address - Fax:
Practice Address - Street 1:1079 AUDREY AVE
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-6402
Practice Address - Country:US
Practice Address - Phone:408-379-0639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-11
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health