Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | A74484 | CA |
NPI | 1073648200 |
---|---|
Provider Name | Dr. Danilo T Tan |
First Address | San Diego, CA 92108-3116 |
Second Address | San Diego, CA 92108-3116 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2007 |
Last Update Date | 25/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H30715 | (02) | |
R059973A | MEDICARE PORTABLE X-RAY (01) | CA |