Basic Information
| Provider Information | |||||||||
| NPI: | 1518453778 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SEDANO | ||||||||
| FirstName: | TANIA | ||||||||
| MiddleName: | EUNICE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 38209 47TH ST E STE C | ||||||||
| Address2: | |||||||||
| City: | PALMDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935523113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6619455984 | ||||||||
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| Practice Location | |||||||||
| Address1: | HERITAGE HEALTH CARE MEDICAL GROUP | ||||||||
| Address2: | 38209 47TH ST EAST, STE C | ||||||||
| City: | PALMDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935523112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612723777 | ||||||||
| FaxNumber: | 6612729107 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2018 | ||||||||
| LastUpdateDate: | 02/11/2019 | ||||||||
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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 | 363LF0000X | 95009390 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.