Healthcare Provider Details

I. General information

NPI: 1982169827
Provider Name (Legal Business Name): STELLA TAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2019
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 MARKET ST
RIVERSIDE CA
92501-1720
US

IV. Provider business mailing address

1950 MARKET ST
RIVERSIDE CA
92501-1720
US

V. Phone/Fax

Practice location:
  • Phone: 951-530-5900
  • Fax: 951-530-5945
Mailing address:
  • Phone: 951-530-5900
  • Fax: 951-530-5945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW124653
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: