Healthcare Provider Details

I. General information

NPI: 1396761003
Provider Name (Legal Business Name): HIMAT TANK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 SHEPARD DR STE 102
SANTA MARIA CA
93454-7016
US

IV. Provider business mailing address

1505 SHEPARD DR STE 102
SANTA MARIA CA
93454-7016
US

V. Phone/Fax

Practice location:
  • Phone: 805-928-9300
  • Fax: 805-928-9790
Mailing address:
  • Phone: 805-928-9300
  • Fax: 805-928-9790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA35478
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: