# TANYA ITANI TAIVAL DO LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003083601
- **Authorized official:** DR. TANYA ITANI TAIVAL D.O. (PROVIDER)
- **Authorized official phone:** (321) 269-0748

## Contact information

- **Practice address:** 875 CENTURY MEDICAL DR, TITUSVILLE, FL 32796-2142
- **Practice address phone:** (321) 269-0748
- **Practice address fax:** (321) 383-2424
- **Mailing address:** 875 CENTURY MEDICAL DR, TITUSVILLE, FL 32796-2142
- **Mailing address phone:** (321) 269-0748
- **Mailing address fax:** (321) 383-2424

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/13/2008
- **Last updated:** 07/28/2008