Healthcare Provider Details

I. General information

NPI: 1366491474
Provider Name (Legal Business Name): HOWARD L TARAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR UCSD MEDICAL CENTER MC-8201
SAN DIEGO CA
92103-9000
US

IV. Provider business mailing address

4552 E TALMADGE DR
SAN DIEGO CA
92116-4827
US

V. Phone/Fax

Practice location:
  • Phone: 858-657-8333
  • Fax: 619-543-3183
Mailing address:
  • Phone: 858-450-2132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC41696
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: