Provider Demographics
NPI:1033777651
Name:TAN, DANIELLE MARGEAUX
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:MARGEAUX
Last Name:TAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 E COLORADO BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-3832
Mailing Address - Country:US
Mailing Address - Phone:626-585-8883
Mailing Address - Fax:
Practice Address - Street 1:3500 E COLORADO BLVD STE 108
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3832
Practice Address - Country:US
Practice Address - Phone:626-585-8883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7873237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist