Provider Demographics
NPI:1912582057
Name:HORENSTEIN, TARAN
Entity type:Individual
Prefix:
First Name:TARAN
Middle Name:
Last Name:HORENSTEIN
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 1:24301 SOUTHLAND DR STE 300
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-1546
Mailing Address - Country:US
Mailing Address - Phone:510-300-3570
Mailing Address - Fax:187-799-2003
Practice Address - Street 1:24301 SOUTHLAND DR STE 300
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-1546
Practice Address - Country:US
Practice Address - Phone:510-300-3570
Practice Address - Fax:187-799-2003
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-10
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty