Provider Demographics
NPI:1538752274
Name:TISCARENO, MARIA A
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:A
Last Name:TISCARENO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16122 SHADY VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-2632
Mailing Address - Country:US
Mailing Address - Phone:909-390-1313
Mailing Address - Fax:
Practice Address - Street 1:1500 S HAVEN AVE STE 190
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-2971
Practice Address - Country:US
Practice Address - Phone:909-390-1313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-13
Last Update Date:2021-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist