Healthcare Provider Details

I. General information

NPI: 1174863971
Provider Name (Legal Business Name): VERNA O TAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2013
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1074 MURRIETA BLVD
LIVERMORE CA
94550-4111
US

IV. Provider business mailing address

5314 ALAGRO CT
DUBLIN CA
94568-8728
US

V. Phone/Fax

Practice location:
  • Phone: 925-443-0980
  • Fax:
Mailing address:
  • Phone: 925-277-1300
  • Fax: 925-277-1897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA15319
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15319
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: