MEDICARE: DR. FRANCISCO TAN PH.D.

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	101YM0800X	Mental Health Counselor
2	103T00000X	Psychologist	215141	CA

General Provider Information

NPI Number	:	1942341607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRANCISCO TAN PH.D.

Provider Business Mailing Address
First Line	:	550 S VERMONT AVE FL 10
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-1912
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	269 S MARIPOSA AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-5407
Country	:	US
Telephone Number	:	213-639-2662
Fax Number	:

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

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	04/23/2021

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