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Individual

AMANDA TAGLE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
7215 55TH STREET, SACRAMENTO, CA 95823-2601
(916) 399-1100
(877) 860-2397
Mailing address
625 FAIR OAKS AVE STE 270, SOUTH PASADENA, CA 91030-5801
(626) 346-2455
(626) 639-3005

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
A60188
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00A601880
MEDI CAL
CA
05
00A601880
CA
01
P01288574/ DS9933
RAILROAD MEDICARE- 55TH ST
CA
01
P01453275-DV5277
RAILROAD MEDICARE
CA
Enumeration date
08/01/2006
Last updated
03/30/2018
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