Provider Demographics
NPI:1730830795
Name:OSPINA, TASEA ALYZA
Entity type:Individual
Prefix:
First Name:TASEA
Middle Name:ALYZA
Last Name:OSPINA
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 1:1020 N SACRAMENTO ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-6157
Mailing Address - Country:US
Mailing Address - Phone:714-351-5167
Mailing Address - Fax:
Practice Address - Street 1:1020 N SACRAMENTO ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-6157
Practice Address - Country:US
Practice Address - Phone:714-351-5167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral