Healthcare Provider Details

I. General information

NPI: 1992725808
Provider Name (Legal Business Name): RONN E TANEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 01/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PEDIATRIC CARDIOLOGY UCSF CTR CLINICAL SCIENCES BLDG, BOX 0632, 521 PARNASSUS AVE
SAN FRANCISCO CA
94143-0001
US

IV. Provider business mailing address

PEDIATRIC CARDIOLOGY UCSF CTR CLINICAL SCIENCES BLDG, BOX 0632, 521 PARNASSUS AVE
SAN FRANCISCO CA
94143-0001
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-3385
  • Fax: 415-476-3112
Mailing address:
  • Phone: 415-476-3385
  • Fax: 415-476-3112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG67277
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberG67277
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: