Individual
DR. TANYA ITANI TAIVAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO LLC
Contact information
Practice address
875 CENTURY MEDICAL DR, TITUSVILLE, FL 32796-2142
(321) 269-0748
(321) 383-2424
Mailing address
875 CENTURY MEDICAL DR, TITUSVILLE, FL 32796-2142
(321) 269-0748
(321) 383-2424
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
OS 9527
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0256154
CIGNA
FL
01
—
14016
BLUE CROSS/BLUE SHIELD
FL
05
—
272865600
—
FL
01
—
7840697
AETNA
FL
01
—
P00240993
MEDICARE RAILROAD
FL
Enumeration date
08/15/2006
Last updated
10/31/2012
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