Provider Demographics
NPI:1558977918
Name:TATO, ALLAN (CAMTC# 67605)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:
Last Name:TATO
Suffix:
Gender:M
Credentials:CAMTC# 67605
Other - Prefix:
Other - First Name:ALLAN SAIPODEN
Other - Middle Name:TADENA
Other - Last Name:TATO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7259 BALBOA BLVD UNIT 16
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-2784
Mailing Address - Country:US
Mailing Address - Phone:818-489-2526
Mailing Address - Fax:
Practice Address - Street 1:7259 BALBOA BLVD UNIT 16
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-2784
Practice Address - Country:US
Practice Address - Phone:818-489-2526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA67605225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist