Healthcare Provider Details

I. General information

NPI: 1700897741
Provider Name (Legal Business Name): MARIA LILIBETH TAN SY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8162 VAN NUYS BLVD
PANORAMA CITY CA
91402-4806
US

IV. Provider business mailing address

425 NOREN ST
LA CANADA CA
91011-2756
US

V. Phone/Fax

Practice location:
  • Phone: 818-787-5800
  • Fax: 818-787-5810
Mailing address:
  • Phone: 818-787-5800
  • Fax: 818-787-5810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA52234
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: