Healthcare Provider Details

I. General information

NPI: 1487040739
Provider Name (Legal Business Name): TANEN TYRELL ST. CLAIR - BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 CONSTITUTION BLVD
SALINAS CA
93906-3100
US

IV. Provider business mailing address

1441 CONSTITUTION BLVD
SALINAS CA
93906-3100
US

V. Phone/Fax

Practice location:
  • Phone: 831-755-4111
  • Fax: 773-537-0029
Mailing address:
  • Phone: 831-755-4111
  • Fax: 773-537-0029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number20A17296
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number80011-21
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: