Provider Demographics
NPI:1043546112
Name:TANCHOCO, IMELDA TAN (MD)
Entity type:Individual
Prefix:DR
First Name:IMELDA
Middle Name:TAN
Last Name:TANCHOCO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21324 STOCKTON PASS RD
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-5111
Mailing Address - Country:US
Mailing Address - Phone:626-233-4964
Mailing Address - Fax:
Practice Address - Street 1:21324 STOCKTON PASS RD
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-5111
Practice Address - Country:US
Practice Address - Phone:626-233-4964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA106359208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics