Provider Demographics
NPI:1720674484
Name:TANG, CHRISTIE ANGELIE
Entity Type:Individual
Prefix:
First Name:CHRISTIE ANGELIE
Middle Name:
Last Name:TANG
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 1:214 ALICANTE AISLE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-8551
Mailing Address - Country:US
Mailing Address - Phone:818-251-0652
Mailing Address - Fax:
Practice Address - Street 1:214 ALICANTE AISLE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-8551
Practice Address - Country:US
Practice Address - Phone:818-251-0652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-16
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95023830163WG0000X
CA95001465367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95001465OtherBRN
CA134684OtherNBCRNA
CA95023830OtherBRN