Healthcare Provider Details

I. General information

NPI: 1952401556
Provider Name (Legal Business Name): ARMANDO TAN OMEGA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 W CAPITOL AVE SUITE A
WEST SACRAMENTO CA
95691-2701
US

IV. Provider business mailing address

1040 W CAPITOL AVE SUITE A
WEST SACRAMENTO CA
95691-2701
US

V. Phone/Fax

Practice location:
  • Phone: 916-372-8657
  • Fax: 916-372-9637
Mailing address:
  • Phone: 916-372-8657
  • Fax: 916-372-9637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number25913
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: