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NPI Code Detail

MEDICARE: TAMMY M VAN

MEDICARE: TAMMY M VAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1205764180
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAMMY M VAN
Provider Business Mailing Address
First Line : 2575 YORBA LINDA BLVD
Second Line :
City : FULLERTON
State : CA
Zip : 92831-1615
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5460 E LA PALMA AVE
Second Line :
City : ANAHEIM
State : CA
Zip : 92807-2023
Country : US
Telephone Number : 714-463-7500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2026
Last Update Date : 05/13/2026

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Directions to “ TAMMY M VAN ” Practice Location

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