Provider Demographics
NPI:1144996216
Name:TADONGDOUONNANG, JANEISA (LPT)
Entity type:Individual
Prefix:
First Name:JANEISA
Middle Name:
Last Name:TADONGDOUONNANG
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 PEPPER DR APT A
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-3337
Mailing Address - Country:US
Mailing Address - Phone:559-404-9387
Mailing Address - Fax:
Practice Address - Street 1:351 WARTHAN ST APT 120
Practice Address - Street 2:
Practice Address - City:COALINGA
Practice Address - State:CA
Practice Address - Zip Code:93210-2654
Practice Address - Country:US
Practice Address - Phone:559-404-9387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-19
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA92180225700000X
167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist