Provider Demographics
NPI:1023877032
Name:WEINSTOCK, TARA RACHEL (RDHAP)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:RACHEL
Last Name:WEINSTOCK
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28279 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350-4434
Mailing Address - Country:US
Mailing Address - Phone:909-210-2213
Mailing Address - Fax:
Practice Address - Street 1:28279 CEDAR LN
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91350-4434
Practice Address - Country:US
Practice Address - Phone:909-210-2213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1064124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist