Provider Demographics
NPI:1023296373
Name:TANTAU, JULIE ANNA (MA)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANNA
Last Name:TANTAU
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:468 S ROXBURY DR
Mailing Address - Street 2:402
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-4149
Mailing Address - Country:US
Mailing Address - Phone:310-843-9532
Mailing Address - Fax:
Practice Address - Street 1:468 S ROXBURY DR
Practice Address - Street 2:402
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-4149
Practice Address - Country:US
Practice Address - Phone:310-843-9532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2430231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist