Provider Demographics
NPI:1932422110
Name:ROBERTS, TANISHA N (RT)
Entity type:Individual
Prefix:
First Name:TANISHA
Middle Name:N
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8608 UTICA AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4877
Mailing Address - Country:US
Mailing Address - Phone:951-347-2426
Mailing Address - Fax:
Practice Address - Street 1:8608 UTICA AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4877
Practice Address - Country:US
Practice Address - Phone:951-347-2426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00020103227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified