Basic Information
| Provider Information | |||||||||
| NPI: | 1194218529 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TEPANOHAYA | ||||||||
| FirstName: | MARIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 447 N EL MOLINO AVE | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911011403 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3600 WILSHIRE BLVD STE 2200 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900102632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2133824400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2018 | ||||||||
| LastUpdateDate: | 02/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
ID Information
| ID | Type | State | Issuer | Description | 7708 | 01 | CA | MEDI-CAL | OTHER | 7368 | 01 | CA | MEDI-CAL | OTHER | 7184 | 01 | CA | MEDI-CAL | OTHER | 7667 | 01 | CA | MEDI-CAL | OTHER |