Healthcare Provider Details

I. General information

NPI: 1073202750
Provider Name (Legal Business Name): RHEALYN TANTIONGCO FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W CARSON ST
TORRANCE CA
90502-2059
US

IV. Provider business mailing address

1350 N MARINE AVE APT 101
WILMINGTON CA
90744-2563
US

V. Phone/Fax

Practice location:
  • Phone: 424-306-6500
  • Fax:
Mailing address:
  • Phone: 310-699-9748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF04230443
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: