Healthcare Provider Details

I. General information

NPI: 1306879036
Provider Name (Legal Business Name): MUMTAZ G TABBAA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 03/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 CONSTITUTION BLVD
SALINAS CA
93906-3100
US

IV. Provider business mailing address

395 DEL MONTE CTR STE 173
MONTEREY CA
93940-6156
US

V. Phone/Fax

Practice location:
  • Phone: 831-755-4111
  • Fax: 831-755-4087
Mailing address:
  • Phone: 831-755-4111
  • Fax: 831-372-1666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA54688
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: