Healthcare Provider Details

I. General information

NPI: 1366494320
Provider Name (Legal Business Name): ADINA TANASESCU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 06/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3660 PARK SIERRA DR SUITE 208
RIVERSIDE CA
92505-3081
US

IV. Provider business mailing address

PO BOX 54130
LOS ANGELES CA
90054-0130
US

V. Phone/Fax

Practice location:
  • Phone: 951-687-2800
  • Fax: 951-687-7290
Mailing address:
  • Phone: 951-687-3400
  • Fax: 951-687-7630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA66943
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA66943
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: