Basic Information
| Provider Information | |||||||||
| NPI: | 1205021375 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NORIEGA | ||||||||
| FirstName: | TAMARA | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | MFTI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 233 BASELINE RD | ||||||||
| Address2: | |||||||||
| City: | LA VERNE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917502353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098332986 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8000 PAINTER AVE | ||||||||
| Address2: | |||||||||
| City: | WHITTIER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906022505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629037000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2007 | ||||||||
| LastUpdateDate: | 06/14/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 102703 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | LMFT106339 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.