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General NPI Number Information
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NPI Number | 1225543119
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Entity Type | Individual
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Provider Name | NICOLE PINEDA TAN PTA
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Gender | Female
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Dates
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Enumeration Date | 12/13/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1101 S ANAHEIM BLVD
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City | ANAHEIM
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State | CA
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Zip | 92805-5811
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Country | US
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Telephone | 714-929-1750
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Fax | 714-937-1966
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Provider Business Mailing Address
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Address Line | 2023 OTTERBEIN AVE
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City | ROWLAND HEIGHTS
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State | CA
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Zip | 91748-3950
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Country | US
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Telephone | 626-251-0315
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA49028
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License Number State | CA
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