Healthcare Provider Details

I. General information

NPI: 1396375275
Provider Name (Legal Business Name): TANYA STEWARD FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2020
Last Update Date: 06/25/2020
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8043 2ND ST STE 105
DOWNEY CA
90241-3692
US

IV. Provider business mailing address

10288 BEVERLY ST
BELLFLOWER CA
90706-6764
US

V. Phone/Fax

Practice location:
  • Phone: 562-862-1134
  • Fax: 562-861-9895
Mailing address:
  • Phone: 402-580-0231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95013656
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: