Healthcare Provider Details

I. General information

NPI: 1467450676
Provider Name (Legal Business Name): ROBERTO CAZAR TONGSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 11/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 BASSETT ST
KING CITY CA
93930-2943
US

IV. Provider business mailing address

212 BASSETT ST
KING CITY CA
93930-2943
US

V. Phone/Fax

Practice location:
  • Phone: 831-386-9542
  • Fax: 831-386-0864
Mailing address:
  • Phone: 831-386-9542
  • Fax: 831-386-0864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number00A54183
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: