Alta-Grace L Tan, PSYD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY18653 Issued in CA

Practice address

17075 Devonshire Street
Ste 204
Northridge, CA 91325-5408

Phone

(818) 368-8929

Fax

(818) 368-8940

NPI assigned

Sep 11, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Asana Integrated Medical Group PC

  • Psychiatry Physician
  • Sioux Falls, SD
  • NPI 1396783379
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1327017600000",
    "number": "1295839322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17075 DEVONSHIRE STREET",
            "address_2": "STE 204",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913255408",
            "telephone_number": "818-368-8929",
            "fax_number": "818-368-8940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17075 DEVONSHIRE STREET",
            "address_2": "STE 204",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913255408",
            "telephone_number": "818-368-8929",
            "fax_number": "818-368-8940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAN",
        "first_name": "ALTA-GRACE",
        "middle_name": "L",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-11",
        "last_updated": "2012-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY18653",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gagik Jack Tagaryan, RN
• Justin Baetiong Talavera, OTR/L
• Draupadi B Talreja, M.D.
• Shadi Tamaddon, NP
• Jeremy Lee Tamayo
• Yuki Tanaka
• Sherri A.C. Tanferani, PH.D.
• Arianne Tang
• Ville S Tanphoon
• Eileen Tapia

• Psychologist in Northridge, CA
• Providers in Northridge, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.