Basic Information
Provider Information | |||||||||
NPI: | 1730518523 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | TENE | ||||||||
FirstName: | MICHELLE | ||||||||
MiddleName: | CHRISTINE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | TENE | ||||||||
OtherFirstName: | MICHELLE | ||||||||
OtherMiddleName: | CHRISTINE | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 2130 E 4TH ST STE 200 | ||||||||
Address2: |   | ||||||||
City: | SANTA ANA | ||||||||
State: | CA | ||||||||
PostalCode: | 927053818 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6576224141 | ||||||||
FaxNumber: | 7145435463 | ||||||||
Practice Location | |||||||||
Address1: | 2130 E 4TH ST STE 200 | ||||||||
Address2: |   | ||||||||
City: | SANTA ANA | ||||||||
State: | CA | ||||||||
PostalCode: | 927053818 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6576224141 | ||||||||
FaxNumber: | 7145435463 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/02/2013 | ||||||||
LastUpdateDate: | 05/27/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X |   | CA | Y |   | Other Service Providers | Case Manager/Care Coordinator |   |
No ID Information.