Provider Demographics
NPI:1063073344
Name:SPODEN, TAHNEE L (MD)
Entity type:Individual
Prefix:
First Name:TAHNEE
Middle Name:L
Last Name:SPODEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25040 EVERETT DR
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-3406
Mailing Address - Country:US
Mailing Address - Phone:925-784-3342
Mailing Address - Fax:
Practice Address - Street 1:200 MEDICAL PLAZA ST 265
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-1282
Practice Address - Country:US
Practice Address - Phone:310-948-4494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA178864390200000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program