Basic Information
| Provider Information | |||||||||
| NPI: | 1942684295 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CERRUTI | ||||||||
| FirstName: | TARA | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | ARNAIZ | ||||||||
| OtherFirstName: | TARA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 9385 ROLLING GLEN CT | ||||||||
| Address2: | |||||||||
| City: | ORANGEVALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956625632 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2750 SUTTERVILLE RD | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958201024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164523981 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2015 | ||||||||
| LastUpdateDate: | 08/23/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 109141 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.