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General NPI Number Information
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NPI Number | 1700897741
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Entity Type | Individual
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Provider Name | MARIA LILIBETH TAN SY M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8162 VAN NUYS BLVD
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City | PANORAMA CITY
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State | CA
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Zip | 91402-4806
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Country | US
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Telephone | 818-787-5800
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Fax | 818-787-5810
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Provider Business Mailing Address
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Address Line | 425 NOREN ST
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City | LA CANADA
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State | CA
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Zip | 91011-2756
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Country | US
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Telephone | 818-787-5800
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Fax | 818-787-5810
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A52234
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License Number State | CA
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