Healthcare Provider Details

I. General information

NPI: 1982905410
Provider Name (Legal Business Name): DR RUTH TANYI, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2010
Last Update Date: 11/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

577 N D ST STE 101
SAN BERNARDINO CA
92401-1326
US

IV. Provider business mailing address

577 N D ST STE 101
SAN BERNARDINO CA
92401-1326
US

V. Phone/Fax

Practice location:
  • Phone: 909-386-1500
  • Fax: 909-386-1588
Mailing address:
  • Phone: 909-386-1500
  • Fax: 909-386-1588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number15272
License Number StateCA

VIII. Authorized Official

Name: DR. RUTH A TANYI
Title or Position: CEO
Credential: NP, DRPH
Phone: 909-386-1500