Healthcare Provider Details

I. General information

NPI: 1407129844
Provider Name (Legal Business Name): NATALIE TJANDRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2012
Last Update Date: 02/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2017 E 4TH ST
LONG BEACH CA
90814-1001
US

IV. Provider business mailing address

2017 E 4TH ST
LONG BEACH CA
90814-1001
US

V. Phone/Fax

Practice location:
  • Phone: 562-434-4455
  • Fax: 562-433-6428
Mailing address:
  • Phone: 562-434-4455
  • Fax: 562-433-6428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: