Individual
DR. ANTONIO A. TAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12980 FREDERICK ST, SUITE D, MORENO VALLEY, CA 92553-5263
(951) 485-2744
Mailing address
12980 FREDERICK ST, SUITE D, MORENO VALLEY, CA 92553-5263
(951) 485-2744
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
A45416
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A454161
—
CA
Enumeration date
01/08/2007
Last updated
07/09/2007
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