Provider Demographics
NPI:1225636194
Name:TANN, AMBER ALEXANDRIA
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:ALEXANDRIA
Last Name:TANN
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 1:1344 251ST ST # 4A
Mailing Address - Street 2:
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710-2843
Mailing Address - Country:US
Mailing Address - Phone:323-494-0472
Mailing Address - Fax:
Practice Address - Street 1:1968 W ADAMS BLVD # 106
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90018-3515
Practice Address - Country:US
Practice Address - Phone:323-731-3534
Practice Address - Fax:323-731-5618
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator