Basic Information
| Provider Information | |||||||||
| NPI: | 1225543119 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAN | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | PINEDA | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2023 OTTERBEIN AVE | ||||||||
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| City: | ROWLAND HEIGHTS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917483950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262510315 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1101 S ANAHEIM BLVD | ||||||||
| Address2: | |||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928055811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149291750 | ||||||||
| FaxNumber: | 7149371966 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2017 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | PTA49028 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.