Provider Demographics
NPI:1720847973
Name:DELARA, TANYA
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:DELARA
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 1:50660 EISENHOWER DR APT 714
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-2333
Mailing Address - Country:US
Mailing Address - Phone:760-619-4257
Mailing Address - Fax:
Practice Address - Street 1:78370 HIGHWAY 111 STE 260
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-2623
Practice Address - Country:US
Practice Address - Phone:760-619-4257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst