Provider Demographics
NPI:1447852512
Name:TATING, JELENA MAE LALIN
Entity type:Individual
Prefix:
First Name:JELENA MAE
Middle Name:LALIN
Last Name:TATING
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 1:722 DEL NORTE ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-5407
Mailing Address - Country:US
Mailing Address - Phone:707-246-1700
Mailing Address - Fax:
Practice Address - Street 1:722 DEL NORTE ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-5407
Practice Address - Country:US
Practice Address - Phone:707-246-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-12
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst