Healthcare Provider Details

I. General information

NPI: 1427178367
Provider Name (Legal Business Name): MAGGIE TAM HAGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MAGGIE L. TAM

II. Dates (important events)

Enumeration Date: 03/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7872 WALKER ST SUITE 200
LA PALMA CA
90623-1796
US

IV. Provider business mailing address

19314 ALCONA ST
ROWLAND HEIGHTS CA
91748-3907
US

V. Phone/Fax

Practice location:
  • Phone: 626-893-8632
  • Fax:
Mailing address:
  • Phone: 626-893-8632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS17474
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: