Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208800000X | Urologist | 2011012612 | MO |
Y | 208800000X | Urologist | A125924 | CA |
NPI | 1003029372 |
---|---|
Provider Name | Dr. Youssef S Tanagho |
First Address | San Diego, CA 92163-3865 |
Second Address | La Mesa, CA 91942-3033 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2007 |
Last Update Date | 25/08/2020 |