| |
1200 S Atlantic Blvd Suite 128 Alhambra CA 91803-2408 | |
(626) 308-3981 | |
Not Available |
Full Name | |
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Speciality | Psychiatry & Neurology |
Location | 1200 S Atlantic Blvd, Alhambra, California |
Authorized Official Name and Position | Michael P Tan (PRESIDENT) |
Authorized Official Contact | 6263083981 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1200 S Atlantic Blvd Suite 128 Alhambra CA 91803-2408 Ph: (626) 308-3981 | 1200 S Atlantic Blvd Suite 128 Alhambra CA 91803-2408 Ph: (626) 308-3981 |
NPI Number | 1861617078 |
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Provider Enumeration Date | 04/14/2007 |
Last Update Date | 04/04/2024 |
Certification Date | 04/04/2024 |
Medicare PECOS PAC ID | 5698672566 |
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Medicare Enrollment ID | O20031217001136 |
Identifier | Type | State | Issuer |
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1861617078 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
Provider Name | Michael P Tan |
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Provider Type | Practitioner - Neurology |
Provider Identifiers | NPI Number: 1760419204 PECOS PAC ID: 2961309836 Enrollment ID: I20110107000325 |
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