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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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