Healthcare Provider Details

I. General information

NPI: 1225041932
Provider Name (Legal Business Name): TANDICE HAWKEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 WESTWOOD PLAZA JD MORGAN CENTER
LOS ANGELES CA
90024
US

IV. Provider business mailing address

1702 HERMOSA AVE #7
HERMOSA BEACH CA
90254-3447
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-4880
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: