Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | A126218 | CA |
Y | 208600000X | Surgeon | A126218 | CA |
N | 208200000X | Surgeon | 46160 | TN |
N | 208600000X | Surgeon | 46160 | TN |
N | 208200000X | Surgeon | A126218 | CA |
N | 208600000X | Surgeon | A126218 | CA |
N | 2086S0105X | Surgery of the Hand | A126218 | CA |
NPI | 1235372376 |
---|---|
Provider Name | Diya H Tantawi |
First Address | Rancho Mirage, CA 92270-3221 |
Second Address | Rancho Mirage, CA 92270-3221 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2009 |
Last Update Date | 24/12/2019 |