Healthcare Provider Details

I. General information

NPI: 1538086996
Provider Name (Legal Business Name): TAN FAMILY PRACTICE NURSING PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17000 UPLAND AVE
FONTANA CA
92335-3535
US

IV. Provider business mailing address

8285 WHEELER AVE
FONTANA CA
92335-3538
US

V. Phone/Fax

Practice location:
  • Phone: 626-905-5957
  • Fax:
Mailing address:
  • Phone: 626-905-5957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ARA TAN
Title or Position: PRESIDENT/OWNER
Credential: NP
Phone: 336-837-8369