Healthcare Provider Details

I. General information

NPI: 1306363056
Provider Name (Legal Business Name): DONNA TANG CARE COORDINATOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2017
Last Update Date: 08/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S LAFAYETTE PARK PLACE 3RD FLOOR
LA CA
90057-5400
US

IV. Provider business mailing address

3242 WILSHIRE BLVD. STE 1000
LA CA
90010
US

V. Phone/Fax

Practice location:
  • Phone: 323-653-4045
  • Fax: 213-383-3146
Mailing address:
  • Phone: 323-653-4045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: