1831317882 NPI number — TANYECH WALFORD, MD INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831317882 NPI number — TANYECH WALFORD, MD INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TANYECH WALFORD, MD INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831317882
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 480078
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90048-1078
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8631 W 3RD ST
Provider Second Line Business Practice Location Address:
SUITE 1040E
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90048-5901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-358-5510
Provider Business Practice Location Address Fax Number:
310-358-5595
Provider Enumeration Date:
04/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WALFORD
Authorized Official First Name:
TANYECH
Authorized Official Middle Name:
PATRICIA
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
310-358-5510

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  A75693 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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