Provider Demographics
NPI:1427486570
Name:TARAZU
Entity type:Organization
Organization Name:TARAZU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAINAGERKER
Authorized Official - Suffix:
Authorized Official - Credentials:QMHP, QMHA
Authorized Official - Phone:702-716-6706
Mailing Address - Street 1:4560 S EASTERN AVE STE 17
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6182
Mailing Address - Country:US
Mailing Address - Phone:702-716-6706
Mailing Address - Fax:
Practice Address - Street 1:4560 S EASTERN AVE STE 17
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6182
Practice Address - Country:US
Practice Address - Phone:702-716-6706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Multi-Specialty