Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 100232 | CA |
N | 225400000X | Rehabilitation Practitioner |
NPI | 1053868059 |
---|---|
Provider Name | Tamara Deangelis |
First Address | Commerce, CA 90040-2449 |
Second Address | Commerce, CA 90040-2449 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2016 |
Last Update Date | 09/09/2021 |