Healthcare Provider Details

I. General information

NPI: 1578811923
Provider Name (Legal Business Name): ALISON TATE MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 01/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CONGRESS ST SUITE 300
PASADENA CA
91105-3045
US

IV. Provider business mailing address

10 CONGRESS ST
PASADENA CA
91105-3045
US

V. Phone/Fax

Practice location:
  • Phone: 626-397-5870
  • Fax: 626-397-5872
Mailing address:
  • Phone: 626-397-5870
  • Fax: 626-597-5872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberA107896
License Number StateCA

VIII. Authorized Official

Name: DR. ALISON L TATE
Title or Position: PHYSICIAN OWNER
Credential: M.D.
Phone: 626-397-5870