Basic Information
| Provider Information | |||||||||
| NPI: | 1023617875 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAUGHAWOUT | ||||||||
| FirstName: | TANYA | ||||||||
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| Credential: | CMT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16412 RHONE LN | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926474129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8053042701 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1202 BRISTOL ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | COSTA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926268607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7144249001 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2020 | ||||||||
| LastUpdateDate: | 10/22/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | 42775 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.