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General NPI Number Information
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NPI Number | 1336665215
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Entity Type | Individual
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Provider Name | ISABEL TADA DOCTORAL INTERN
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Gender | Female
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Dates
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Enumeration Date | 08/22/2017
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Last Update Date | 08/22/2017
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Provider Practice Location Address
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Address Line | 5675 W OLYMPIC BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90036-4712
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Country | US
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Telephone | 323-965-1365
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1433
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City | CHINO
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State | CA
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Zip | 91708-1433
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Country | US
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Telephone |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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