=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912280868
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMERALD T TADIAMAN RPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2011
-----------------------------------------------------
Last Update Date | 09/27/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1115 W AVENUE M14
-----------------------------------------------------
City | PALMDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93551-1407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-265-0060
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 43251 HOMESTEAD ST
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93535-4969
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-946-6499
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT28502
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------