Individual
MR. THANUTTHA TIENSAWANG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.N.
Contact information
Practice address
21529 SATICOY ST, UNIT #106, CANOGA PARK, CA 91304-4958
(310) 478-3711
Mailing address
21529 SATICOY ST, UNIT #106, CANOGA PARK, CA 91304-4958
(310) 478-3711
Taxonomy
Speciality
Code
Description
License number
State
163WE0900X
Enterostomal Therapy Registered Nurse
Primary
545790
CA
Other
Enumeration date
06/10/2008
Last updated
06/10/2008
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