Healthcare Provider Details

I. General information

NPI: 1336131911
Provider Name (Legal Business Name): DAN B TARANGO DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8851 CENTER DR #201
LA MESA CA
91942-3017
US

IV. Provider business mailing address

8851 CENTER DR #201
LA MESA CA
91942-3017
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 Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number000378
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: