Healthcare Provider Details

I. General information

NPI: 1235160003
Provider Name (Legal Business Name): ZIAD TANNOUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 N INDIAN CANYON ROAD SUITE #208W
PALM SPRINGS CA
92262
US

IV. Provider business mailing address

PO BOX 5047
PALM SPRINGS CA
92263
US

V. Phone/Fax

Practice location:
  • Phone: 760-323-4416
  • Fax: 760-323-2668
Mailing address:
  • Phone: 760-323-4416
  • Fax: 760-323-2668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA54040
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA54040
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: