Healthcare Provider Details

I. General information

NPI: 1629147533
Provider Name (Legal Business Name): ARTOTELES L TANDINCO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 03/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3393 PEBBLE BEACH CT
FAIRFIELD CA
94534-8308
US

IV. Provider business mailing address

1564A FITZGERALD DR # 158
PINOLE CA
94564-2229
US

V. Phone/Fax

Practice location:
  • Phone: 707-372-3801
  • Fax: 949-757-2534
Mailing address:
  • Phone: 707-372-3801
  • Fax: 949-757-2534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA44894
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: