Individual
JERICK TAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1500 E DUARTE ROAD, DUARTE, CA 91010
(626) 256-4673
Mailing address
17952 E EDNA PL, COVINA, CA 91722-3201
(626) 673-2210
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
95008276
CA
Other
Enumeration date
02/21/2018
Last updated
11/13/2020
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