Provider Demographics
NPI:1962269522
Name:CHAVARRIA, TANIA SIRZARETH
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:SIRZARETH
Last Name:CHAVARRIA
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 1:1054 GRANADA DR
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-3517
Mailing Address - Country:US
Mailing Address - Phone:415-368-3340
Mailing Address - Fax:
Practice Address - Street 1:80 EUREKA SQ STE 151
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-2603
Practice Address - Country:US
Practice Address - Phone:415-368-3340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95713225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist