Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207ND0101X | MOHS-Micrographic Surgeon | A60419 | CA |
Y | 207NS0135X | Procedural Dermatology | A60419 | CA |
NPI | 1497706113 |
---|---|
Provider Name | Tanya Jeanette Foreman |
First Address | Henderson, NV 89074-7759 |
Second Address | Newport Beach, CA 92660-7601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2006 |
Last Update Date | 09/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G66423 | (02) | CA |