Provider Demographics
NPI:1518453778
Name:SEDANO, TANIA EUNICE
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:EUNICE
Last Name:SEDANO
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 1:38209 47TH ST E STE C
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93552-3113
Mailing Address - Country:US
Mailing Address - Phone:661-945-5984
Mailing Address - Fax:
Practice Address - Street 1:HERITAGE HEALTH CARE MEDICAL GROUP
Practice Address - Street 2:38209 47TH ST EAST, STE C
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93552-3112
Practice Address - Country:US
Practice Address - Phone:661-272-3777
Practice Address - Fax:661-272-9107
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95009390363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily