Basic Information
| Provider Information | |||||||||
| NPI: | 1588913420 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LUANN L. TAM, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 185 S. MOUNTAIN TRAIL | ||||||||
| Address2: | |||||||||
| City: | SIERRA MADRE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910242666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6268629788 | ||||||||
| FaxNumber: | 6263550127 | ||||||||
| Practice Location | |||||||||
| Address1: | 185 S. MOUNTAIN TRAIL | ||||||||
| Address2: | |||||||||
| City: | SIERRA MADRE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910242666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6268629788 | ||||||||
| FaxNumber: | 6263550127 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2012 | ||||||||
| LastUpdateDate: | 09/06/2012 | ||||||||
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| AuthorizedOfficialLastName: | TAM | ||||||||
| AuthorizedOfficialFirstName: | LUANN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6268629788 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CNM, NP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 512 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.