Provider Demographics
NPI:1558059394
Name:TANAHAN, EMIN (PMHNP-BC, MSN,RN,PHN)
Entity Type:Individual
Prefix:MR
First Name:EMIN
Middle Name:
Last Name:TANAHAN
Suffix:
Gender:M
Credentials:PMHNP-BC, MSN,RN,PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 LAUDERDALE AVE
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-1032
Mailing Address - Country:US
Mailing Address - Phone:818-497-0100
Mailing Address - Fax:
Practice Address - Street 1:11111 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-4655
Practice Address - Country:US
Practice Address - Phone:818-497-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-28
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95165517163WP0808X, 163WP0809X
CA556640364SC1501X
CA95024785363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No364SC1501XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCommunity Health/Public Health