Healthcare Provider Details

I. General information

NPI: 1457339558
Provider Name (Legal Business Name): AMENRA F TUASON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 12/03/2021
Certification Date: 12/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CENTRAL STATE HOSPITAL WASHINGTON ST
PETERSBURG VA
23803-0030
US

IV. Provider business mailing address

PO BOX 11768
RICHMOND VA
23230-0168
US

V. Phone/Fax

Practice location:
  • Phone: 804-524-4700
  • Fax: 804-524-4717
Mailing address:
  • Phone: 804-281-3319
  • Fax: 804-213-9773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number0101041739
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: