Provider Demographics
NPI:1417366675
Name:TAM, JEANETTE (MSW INTERN STUDENT)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:TAM
Suffix:
Gender:F
Credentials:MSW INTERN STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-1705
Mailing Address - Country:US
Mailing Address - Phone:213-483-3000
Mailing Address - Fax:213-383-3146
Practice Address - Street 1:1310 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-1705
Practice Address - Country:US
Practice Address - Phone:213-483-3000
Practice Address - Fax:213-383-3146
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program