Individual
ALTA-GRACE L TAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
17075 DEVONSHIRE STREET, STE 204, NORTHRIDGE, CA 91325-5408
(818) 368-8929
(818) 368-8940
Mailing address
17075 DEVONSHIRE STREET, STE 204, NORTHRIDGE, CA 91325-5408
(818) 368-8929
(818) 368-8940
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY18653
CA
Other
Enumeration date
09/11/2006
Last updated
01/20/2012
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