Provider Demographics
NPI:1184151235
Name:RAMON, REGILAH ANN TAN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:REGILAH ANN
Middle Name:TAN
Last Name:RAMON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4775 E PACIFIC COAST HWY APT 304
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-3261
Mailing Address - Country:US
Mailing Address - Phone:310-910-4756
Mailing Address - Fax:
Practice Address - Street 1:31236 PALOS VERDES DR W
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-5361
Practice Address - Country:US
Practice Address - Phone:310-544-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95006381363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care