Healthcare Provider Details

I. General information

NPI: 1770381436
Provider Name (Legal Business Name): TAMIKA HENRY MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2025
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 ARDEN AVE STE 101
GLENDALE CA
91203-4023
US

IV. Provider business mailing address

4611 VINETA AVE
LA CANADA CA
91011-2618
US

V. Phone/Fax

Practice location:
  • Phone: 323-496-0134
  • Fax:
Mailing address:
  • Phone: 323-496-0134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TAMIKA HENRY
Title or Position: OWNER
Credential: MD/OWNER
Phone: 323-496-0134