Provider Demographics
NPI:1588913420
Name:LUANN L. TAM, INC
Entity type:Organization
Organization Name:LUANN L. TAM, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUANN
Authorized Official - Middle Name:
Authorized Official - Last Name:TAM
Authorized Official - Suffix:
Authorized Official - Credentials:CNM, NP
Authorized Official - Phone:626-862-9788
Mailing Address - Street 1:185 S. MOUNTAIN TRAIL
Mailing Address - Street 2:
Mailing Address - City:SIERRA MADRE
Mailing Address - State:CA
Mailing Address - Zip Code:91024-2666
Mailing Address - Country:US
Mailing Address - Phone:626-862-9788
Mailing Address - Fax:626-355-0127
Practice Address - Street 1:185 S. MOUNTAIN TRAIL
Practice Address - Street 2:
Practice Address - City:SIERRA MADRE
Practice Address - State:CA
Practice Address - Zip Code:91024-2666
Practice Address - Country:US
Practice Address - Phone:626-862-9788
Practice Address - Fax:626-355-0127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA512367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty