Provider Information for 1184908758
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Ms. NANETTE TANGKEKO
Sex: Female
NPI: 1184908758
Last Updated: 2019-12-23
Certification Date: 2019-12-23
Certification Date: 2019-12-23
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1184908758 | ||||||||
| Enumeration Date | 2011-09-30 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 9663 SANTA MONICA BLVD 347 BEVERLY HILLS, CA 90210-4303 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 4000 W METROPOLITAN DR ORANGE, CA 92868-3504 United States Phone: 201-303-0916 | Fax: | ||||||||
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