Basic Information
| Provider Information | |||||||||
| NPI: | 1487021515 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUANUXCO | ||||||||
| FirstName: | TLALLI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1202 W CIVIC CENTER DR STE 205 | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927032251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7142450045 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1202 W CIVIC CENTER DR STE 205 | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927032251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7142450045 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2015 | ||||||||
| LastUpdateDate: | 12/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 172V00000X | Y | Other Service Providers | Community Health Worker |
No ID Information.