MEDICARE: DR. ALFREDO B. TIU D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	20A7678	CA

General Provider Information

NPI Number	:	1043215502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALFREDO B. TIU D.O.

Provider Business Mailing Address
First Line	:	200 W ARBOR DR
Second Line	:	OWEN CLINIC
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-9001
Country	:	US
Telephone Number	:	619-543-2415
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 W ARBOR DR
Second Line	:	OWEN CLINIC
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-9001
Country	:	US
Telephone Number	:	619-543-2415
Fax Number	:	619-543-2415

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	08/27/2007

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