Provider Demographics
NPI:1144694381
Name:LOAIZA TANGARIFE, DIANA MARIA (MA)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:MARIA
Last Name:LOAIZA TANGARIFE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 EDINBROOK CT
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-3717
Mailing Address - Country:US
Mailing Address - Phone:612-770-1507
Mailing Address - Fax:
Practice Address - Street 1:5005 1/2 34TH AVE S UNIT 3
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-1542
Practice Address - Country:US
Practice Address - Phone:612-548-1543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-28
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2892106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist