Individual
CURTIS TAGUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
118 E AIRPORT DR, STE 201, SAN BERNARDINO, CA 92408-3472
(909) 890-2532
Mailing address
PO BOX 7630, LAGUNA NIGUEL, CA 92607-7630
Taxonomy
Speciality
Code
Description
License number
State
246Q00000X
Pathology Specialist/Technologist
—
CA
246QM0706X
Medical Technologist
Primary
—
CA
246R00000X
Pathology Technician
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZZ24690Z
—
CA
01
—
ZZZ67434Z
BLUE CROSS/BLUE SHIELD
CA
Enumeration date
09/20/2006
Last updated
03/31/2009
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