| Doctor Name: | MRS. MICHELLE TARDANICO |
| NPI Number: | 1033463617 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | BASW |
| License Number: | |
| Business Practice Address: | 17800 Us Highway 18 Apple Valley, CA - 923071221 |
| Business Phone Number: | 7602426636 |
| Business Fax Number: | 7609460819 |
| Mailing Address: | 17800 Us Highway 18, APPLE VALLEY |
| State: | CA |
| Postal Code: | 923071221 |
| Phone Number: | 7602426636 |
| Fax Number: | 7609460819 |
| NPI Enumeration Date: | 11/03/2012 |
| NPI Last Update Date: | 11/03/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |