Provider Demographics
NPI:1629581988
Name:TANGEROAD, LLC
Entity Type:Organization
Organization Name:TANGEROAD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MATIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJABOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-380-2811
Mailing Address - Street 1:229 N CENTRAL AVE STE 402
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-3542
Mailing Address - Country:US
Mailing Address - Phone:424-380-2811
Mailing Address - Fax:424-270-1888
Practice Address - Street 1:229 N CENTRAL AVE STE 402
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-3542
Practice Address - Country:US
Practice Address - Phone:424-380-2811
Practice Address - Fax:424-270-1888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-08
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health