Tan, Antonio A.

Tan, Antonio A. is an individual health care provider with primary practice located at 12980 Frederick St Suite D, Moreno Valley CA 92553-5263. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Tan, Antonio A. can be contacted via phone (951) 485-2744.

Contact Information

Primary practice address
12980 Frederick St Suite D Moreno Valley CA 92553-5263
Phone: (951) 485-2744
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X A45416 California

Profile Details

NPI number 1134277569
LBN Legal business name Tan, Antonio A.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 8th, 2007
Last updated Jul 9th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1134277569 NPPES
California MEDICAID 00A454161

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