Provider Demographics
NPI:1285826040
Name:TAMASAN, DELIA
Entity Type:Individual
Prefix:DR
First Name:DELIA
Middle Name:
Last Name:TAMASAN
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 1:9532 CHARLENE CIR
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92841-3821
Mailing Address - Country:US
Mailing Address - Phone:714-606-3600
Mailing Address - Fax:
Practice Address - Street 1:1108 E KATELLA AVE
Practice Address - Street 2:C5
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-5043
Practice Address - Country:US
Practice Address - Phone:714-633-7933
Practice Address - Fax:714-633-6570
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
CA43400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Yes174H00000XOther Service ProvidersHealth Educator