Individual
MS. DIANE TAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1115 S SUNSET AVE, WEST COVINA, CA 91790-3940
(626) 962-4011
Mailing address
11625 CANTLAY ST, NORTH HOLLYWOOD, CA 91605-3941
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
52826
CA
Other
Enumeration date
09/21/2015
Last updated
01/11/2016
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