Provider Demographics
NPI:1801396775
Name:TASSA, MERAV
Entity Type:Individual
Prefix:
First Name:MERAV
Middle Name:
Last Name:TASSA
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 1:18404 COLLINS ST APT 220
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2326
Mailing Address - Country:US
Mailing Address - Phone:818-921-0444
Mailing Address - Fax:
Practice Address - Street 1:18404 COLLINS ST APT 220
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2326
Practice Address - Country:US
Practice Address - Phone:818-921-0444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-17
Last Update Date:2018-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner