Healthcare Provider Details

I. General information

NPI: 1679535579
Provider Name (Legal Business Name): TITO ANDRES TANGUILIG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 10/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5342 DUDLEY BLVD
MCCLELLAN CA
95652-1012
US

IV. Provider business mailing address

5342 DUDLEY BLVD
MCCLELLAN CA
95652-1012
US

V. Phone/Fax

Practice location:
  • Phone: 916-561-7400
  • Fax:
Mailing address:
  • Phone: 916-561-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME72447
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: