MEDICARE: MS. TARA M ABBONDANZA NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	13616	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0376694	OTHER	CA	ANCC
2	13616	OTHER	CA	BRN

General Provider Information

NPI Number	:	1730355173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TARA M ABBONDANZA NP

Provider Business Mailing Address
First Line	:	PO BOX 80011
Second Line	:
City	:	CITY OF INDUSTRY
State	:	CA
Zip	:	91716-8011
Country	:	US
Telephone Number	:	267-932-8856
Fax Number	:	626-793-6262

Provider Business Practice Location Address
First Line	:	289 W HUNTINGTON DR STE 401
Second Line	:
City	:	ARCADIA
State	:	CA
Zip	:	91007-3493
Country	:	US
Telephone Number	:	626-254-0074
Fax Number	:	626-254-0079

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2008
Last Update Date	:	07/30/2024

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