Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | A22279 | CA |
Y | 207Q00000X | Family Doctor | A22279 | CA |
N | 208000000X | Pediatrician | A22279 | CA |
NPI | 1053401802 |
---|---|
Provider Name | Marianne Tahl |
First Address | Hemet, CA 92544 |
Second Address | Hemet, CA 92544 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 19/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A86502 | (02) | CA |