Provider Information for 1073078028
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TARA CHRISTINE EGEMO LMFT
Sex: Female
NPI: 1073078028
Last Updated: 2019-03-11
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1073078028 | ||||||||
| Enumeration Date | 2019-02-04 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 6132 ZELZAH AVE ENCINO, CA 91316-7127 United States Phone: 619-865-4783 | Fax: | ||||||||
| Primary Practice Address | 2627 MISSION ST SAN MARINO, CA 91108-1639 United States Phone: 619-865-4783 | Fax: | ||||||||
| Secondary Practice Address(es) | 2120 HUNTINGTON DR STE A | ||||||||
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