Provider Demographics
NPI:1710557566
Name:RAWAS, TANIA
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:RAWAS
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 1:4015 CROWN POINT DR UNIT 110
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-6210
Mailing Address - Country:US
Mailing Address - Phone:513-382-7788
Mailing Address - Fax:
Practice Address - Street 1:4015 CROWN POINT DR UNIT 110
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-6210
Practice Address - Country:US
Practice Address - Phone:513-382-7788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76246183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist