Provider Demographics
NPI:1992535918
Name:TAN, NEMIA LEDESMA (PHD)
Entity type:Individual
Prefix:DR
First Name:NEMIA
Middle Name:LEDESMA
Last Name:TAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 892
Mailing Address - Street 2:
Mailing Address - City:RAMAH
Mailing Address - State:NM
Mailing Address - Zip Code:87321-0892
Mailing Address - Country:US
Mailing Address - Phone:323-702-6978
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 892
Practice Address - Street 2:
Practice Address - City:RAMAH
Practice Address - State:NM
Practice Address - Zip Code:87321-0892
Practice Address - Country:US
Practice Address - Phone:505-782-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM363221103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool