1922590447 NPI number — DR. NATHAN TANOUE MD

Table of content: DR. NATHAN TANOUE MD (NPI 1922590447)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922590447 NPI number — DR. NATHAN TANOUE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TANOUE
Provider First Name:
NATHAN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922590447
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1501 N CAMPBELL, ROOM 4334
Provider Second Line Business Mailing Address:
PO BOX 245058
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85724-5058
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-626-7747
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2335 STOCKTON BLVD.
Provider Second Line Business Practice Location Address:
NAOB 5TH FLOOR
Provider Business Practice Location Address City Name:
SACREMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-734-5638
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/31/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2086S0102X , with the licence number:  A195514 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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