Individual
CZE-JA TAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
504 S SIERRA MADRE BLVD, PASADENA, CA 91107-5240
(626) 795-8811
Mailing address
504 S SIERRA MADRE BLVD, PASADENA, CA 91107-5240
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
689654
NY
163W00000X
Registered Nurse
95082813
CA
363LP0200X
Pediatric Nurse Practitioner
Primary
95004203
CA
Other
Enumeration date
07/16/2015
Last updated
07/28/2016
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