Basic Information
| Provider Information | |||||||||
| NPI: | 1225636194 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TANN | ||||||||
| FirstName: | AMBER | ||||||||
| MiddleName: | ALEXANDRIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1344 251ST ST # 4A | ||||||||
| Address2: | |||||||||
| City: | HARBOR CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907102843 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3234940472 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1968 W ADAMS BLVD # 106 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900183515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3237313534 | ||||||||
| FaxNumber: | 3237315618 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2020 | ||||||||
| LastUpdateDate: | 07/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.