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Individual

WANTING TAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PMHNP

Contact information

Practice address
4929 WILSHIRE BLVD STE 510, LOS ANGELES, CA 90010-3820
(562) 904-3999
Mailing address
4929 WILSHIRE BLVD, SUITE 510, LOS ANGELES, CA 90010
(562) 904-3999

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
95047227
CA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95005097
CA

Other

Enumeration date
10/06/2015
Last updated
07/21/2022
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