Healthcare Provider Details

I. General information

NPI: 1790982312
Provider Name (Legal Business Name): ANA R TANASE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10390 N LA CANADA DR STE 110
TUCSON AZ
85737-7273
US

IV. Provider business mailing address

1856 E INNOVATION PARK DR
ORO VALLEY AZ
85755-1963
US

V. Phone/Fax

Practice location:
  • Phone: 520-420-2110
  • Fax:
Mailing address:
  • Phone: 520-825-7111
  • Fax: 520-818-1253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number44828
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: