Basic Information
| Provider Information | |||||||||
| NPI: | 1881856870 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GREENWOOD | ||||||||
| FirstName: | TANIA | ||||||||
| MiddleName: | ZOHAIR | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1236 N MAGNOLIA AVE | ||||||||
| Address2: | |||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928012607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149951000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1236 N MAGNOLIA AVE | ||||||||
| Address2: | |||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928012607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149951000 | ||||||||
| FaxNumber: | 7148287926 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2008 | ||||||||
| LastUpdateDate: | 08/26/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 19121 | CA | Y | Behavioral Health & Social Service Providers | Social Worker |
ID Information
| ID | Type | State | Issuer | Description | MSW191210 | 05 | CA | MEDICAID |