Healthcare Provider Details

I. General information

NPI: 1558674655
Provider Name (Legal Business Name): RAZAN TAHA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2010
Last Update Date: 03/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W MAIN ST
TURLOCK CA
95380-5107
US

IV. Provider business mailing address

500 E REMINGTON DR STE 20
SUNNYVALE CA
94087-2657
US

V. Phone/Fax

Practice location:
  • Phone: 209-668-5388
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA124179
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: