Provider Demographics
NPI:1154944833
Name:TAN, ISABELLA MARIA CAMELLO
Entity type:Individual
Prefix:
First Name:ISABELLA MARIA
Middle Name:CAMELLO
Last Name:TAN
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 1:101 BRIDEWELL ST APT 330
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-3790
Mailing Address - Country:US
Mailing Address - Phone:714-305-7407
Mailing Address - Fax:
Practice Address - Street 1:1000 S FREMONT AVE # 5100
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-8800
Practice Address - Country:US
Practice Address - Phone:626-407-0740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician