MEDICARE: DR. KEEGAN TANGEMAN PSYD

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
1	103TC2200X	Clinical Child & Adolescent Psychologist	PSY 23288	CA

General Provider Information

NPI Number	:	1407998586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEEGAN TANGEMAN PSYD

Provider Business Mailing Address
First Line	:	4880 MARKET ST
Second Line	:
City	:	VENTURA
State	:	CA
Zip	:	93003-7783
Country	:	US
Telephone Number	:	805-644-7827
Fax Number	:	877-644-7545

Provider Business Practice Location Address
First Line	:	6101 W CENTINELA AVE
Second Line	:	SUITE 380
City	:	CULVER CITY
State	:	CA
Zip	:	90230-6337
Country	:	US
Telephone Number	:	310-337-7827
Fax Number	:	877-644-7545

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	01/16/2015

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