Provider Demographics
NPI:1124277751
Name:TANDAS, DOUANGTAVANH PHOMMISAI
Entity type:Individual
Prefix:MRS
First Name:DOUANGTAVANH
Middle Name:PHOMMISAI
Last Name:TANDAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 LAMPASAS AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-2257
Mailing Address - Country:US
Mailing Address - Phone:916-501-2693
Mailing Address - Fax:
Practice Address - Street 1:820 LAMPASAS AVE APT 4
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-2257
Practice Address - Country:US
Practice Address - Phone:916-501-2693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor