Healthcare Provider Details

I. General information

NPI: 1689809840
Provider Name (Legal Business Name): DAN B TARANGO D P M INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2009
Last Update Date: 05/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8875 LA MESA BLVD SUITE A
LA MESA CA
91941-5100
US

IV. Provider business mailing address

8875 LA MESA BLVD SUITE A
LA MESA CA
91941-5100
US

V. Phone/Fax

Practice location:
  • Phone: 619-461-2990
  • Fax: 619-461-7959
Mailing address:
  • Phone: 619-461-2990
  • Fax: 619-461-7959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE1308
License Number StateCA

VIII. Authorized Official

Name: LYDIA A TARANGO
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 619-461-2990