Organization
ANTONIO A. TAN, MD, PROFESSIONAL CORPORATION
Active
Organization
ANTONIO A. TAN, MD, PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RHODA J. TAN RHIA (MANAGER / SECRETARY OF P.C.)
(951) 485-2744
Entity
Organization
Contact information
Practice address
12980 FREDERICK ST, SUITE D, MORENO VALLEY, CA 92553-5263
(951) 485-2744
(951) 485-2749
Mailing address
12980 FREDERICK ST, SUITE D, MORENO VALLEY, CA 92553-5263
(951) 485-2744
(951) 485-2749
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
A45416
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A454161
—
CA
Enumeration date
04/12/2006
Last updated
08/22/2020
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