Provider Demographics
NPI:1861103350
Name:TAN, KAMILA (MPH)
Entity type:Individual
Prefix:
First Name:KAMILA
Middle Name:
Last Name:TAN
Suffix:
Gender:F
Credentials:MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 LOMA DR APT 1
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-3818
Mailing Address - Country:US
Mailing Address - Phone:619-990-1972
Mailing Address - Fax:
Practice Address - Street 1:1314 LOMA DR APT 1
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-3818
Practice Address - Country:US
Practice Address - Phone:619-990-1972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health