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General NPI Number Information
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NPI Number | 1528866829
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Entity Type | Organization
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Legal Business Name | TLN PROFESSIONAL SERVICES WEST, PC
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Dates
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Enumeration Date | 03/04/2025
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Last Update Date | 10/01/2025
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Provider Practice Location Address
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Address Line | 8325 UNIVERSITY AVE
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City | LA MESA
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State | CA
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Zip | 91942-9322
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Country | US
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Telephone | 888-510-0059
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Fax |
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Provider Business Mailing Address
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Address Line | 1621 W CARROLL AVE
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City | CHICAGO
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State | IL
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Zip | 60612-2501
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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 | PRESIDENT AND SECRETARY
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Name | INSIYAH AAMIR GOMBERAWALLA
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Credential | MD
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Telephone | 708-872-7653
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WL0100X
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Taxonomy Name | Lactation Consultant (Registered Nurse)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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License Number |
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License Number State |
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