Individual
IRMGARD UNA TACKIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
15290 SUMMIT AVE, SUITE B, FONTANA, CA 92336-0240
(909) 225-1900
Mailing address
16096 PITZER ST, FONTANA, CA 92336-4530
(865) 591-1988
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
A118539
CA
Other
Enumeration date
08/03/2009
Last updated
12/08/2021
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