Healthcare Provider Details

I. General information

NPI: 1881815405
Provider Name (Legal Business Name): TANIA RAMAK TAJALLI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 12/02/2021
Certification Date: 12/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 SUNSET BLVD, MODULE 4B
LOS ANGELES CA
90027
US

IV. Provider business mailing address

4900 SUNSET BLVD, MODULE 4B
LOS ANGELES CA
90027
US

V. Phone/Fax

Practice location:
  • Phone: 323-783-8355
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VH0002X
TaxonomyHospice and Palliative Medicine (Obstetrics & Gynecology) Physician
License NumberA95807
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: