Individual
CARMELA CHUA TAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C.
Contact information
Practice address
200 W ARBOR DR, SAN DIEGO, CA 92103-9000
(800) 926-8273
(888) 539-8781
Mailing address
FILE 57326, LOS ANGELES, CA 90074-0001
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA18675
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0PA186750
BLUE SHIELD OF CA
—
01
—
A078
CHAMPUS
—
05
—
PA18675
—
CA
Enumeration date
11/14/2006
Last updated
04/22/2024
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