Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | G14672 | CA |
NPI | 1124021936 |
---|---|
Provider Name | James P. Tasto |
First Address | San Diego, CA 92120-5256 |
Second Address | San Diego, CA 92120-5256 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2005 |
Last Update Date | 15/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G146720 | (05) | CA |
A39306 | (02) | CA |
WG14672D | MEDICARE ID (01) | CA |