Provider Demographics
NPI:1730268145
Name:TARANGO, GINA ELIZABETH (MASTERS DEGREE)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:ELIZABETH
Last Name:TARANGO
Suffix:
Gender:F
Credentials:MASTERS DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5051 SUMMERHILL RD
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91737-1689
Mailing Address - Country:US
Mailing Address - Phone:909-447-6497
Mailing Address - Fax:
Practice Address - Street 1:250 W 1ST ST
Practice Address - Street 2:SUITE 214
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-4736
Practice Address - Country:US
Practice Address - Phone:909-447-6497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36021101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health