Individual
COURTNEY TA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3400 W BALL RD STE 104, ANAHEIM, CA 92804-3735
(949) 432-9989
Mailing address
3151 AIRWAY AVE STE T3, COSTA MESA, CA 92626-4627
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
01/12/2021
Last updated
05/21/2022
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