Provider Demographics
NPI:1154741858
Name:TAN, ANNA MARIA MAGLUNOG (DPM)
Entity type:Individual
Prefix:
First Name:ANNA MARIA
Middle Name:MAGLUNOG
Last Name:TAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1135 S SUNSET AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3937
Mailing Address - Country:US
Mailing Address - Phone:626-918-6655
Mailing Address - Fax:626-918-8614
Practice Address - Street 1:412 W CARROLL AVE STE 107
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-4708
Practice Address - Country:US
Practice Address - Phone:626-963-8351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-21
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5307213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery