Healthcare Provider Details

I. General information

NPI: 1437178274
Provider Name (Legal Business Name): DAN T LA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6673 FOOTHILL BLVD
TUJUNGA CA
91042-2706
US

IV. Provider business mailing address

6673 FOOTHILL BLVD
TUJUNGA CA
91042-2706
US

V. Phone/Fax

Practice location:
  • Phone: 818-265-2250
  • Fax: 818-265-2268
Mailing address:
  • Phone: 818-265-2250
  • Fax: 818-265-2268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberA84795
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: