Active NPI
Marian Martha Depatillo Tan, PHARMD
- Ambulatory Care Pharmacist
- Los Angeles, CA
National Provider Identifier
1609753334
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ambulatory Care Pharmacist
- License
- 91483
- Practice address
- 615 S Atlantic Blvd
Los Angeles, CA 90022-3211 - Phone
- (323) 825-8256
- Fax
- (323) 825-8358
- NPI assigned
- Aug 15, 2025
- Last updated
- Aug 31, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulatory Care Pharmacist | 1835P2201X | 91483 | CA | Primary |
Addresses
Primary practice location
615 S Atlantic Blvd
Los Angeles, CA 90022-3211
Mailing address
1943 W 29TH St
Long Beach, CA 90810-2906
Phone (323) 825-8256
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 49128 | CA | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1755216000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1788134400000",
"number": "1609753334",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1943 W 29TH ST",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908102906",
"telephone_number": "323-825-8256",
"fax_number": "323-825-8358"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "615 S ATLANTIC BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900223211",
"telephone_number": "323-825-8256",
"fax_number": "323-825-8358"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAN",
"first_name": "MARIAN MARTHA",
"middle_name": "DEPATILLO",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-08-15",
"last_updated": "2026-08-31",
"certification_date": "2026-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "1835P2201X",
"taxonomy_group": "",
"desc": "Pharmacist, Ambulatory Care",
"state": "CA",
"license": "91483",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.