Provider Demographics
NPI:1528866829
Name:TLN PROFESSIONAL SERVICES WEST, PC
Entity type:Organization
Organization Name:TLN PROFESSIONAL SERVICES WEST, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:INSIYAH
Authorized Official - Middle Name:AAMIR
Authorized Official - Last Name:GOMBERAWALLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-872-7653
Mailing Address - Street 1:1621 W CARROLL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-2501
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8325 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-9322
Practice Address - Country:US
Practice Address - Phone:888-510-0059
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty
No163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Multi-Specialty