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Individual

DR. TISSA R HATA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
200 WEST ARBOR DRIVE MC 8201, UCSD MEDICAL CENTER, SAN DIEGO, CA 92103-8201
(619) 543-3365
(619) 543-3183
Mailing address
PO BOX 232410, SAN DIEGO, CA 92193-2410

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
G63547
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00G635470
CA
Enumeration date
05/16/2006
Last updated
06/08/2020
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