Provider Demographics
NPI:1871221648
Name:FOY, TANIQUA
Entity type:Individual
Prefix:
First Name:TANIQUA
Middle Name:
Last Name:FOY
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 1:1750 PRAIRIE CITY RD
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-9595
Mailing Address - Country:US
Mailing Address - Phone:424-248-8641
Mailing Address - Fax:
Practice Address - Street 1:1750 PRAIRIE CITY RD
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-9595
Practice Address - Country:US
Practice Address - Phone:424-248-8641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1811550007Medicaid