Individual
MRS. DOUANGTAVANH PHOMMISAI TANDAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
820 LAMPASAS AVE APT 4, SACRAMENTO, CA 95815-2257
(916) 501-2693
Mailing address
820 LAMPASAS AVE APT 4, SACRAMENTO, CA 95815-2257
(916) 501-2693
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
09/18/2008
Last updated
09/18/2008
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