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General NPI Number Information
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NPI Number | 1003083601
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Entity Type | Organization
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Legal Business Name | TANYA ITANI TAIVAL DO LLC
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Dates
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Enumeration Date | 05/13/2008
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Last Update Date | 07/28/2008
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Provider Practice Location Address
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Address Line | 875 CENTURY MEDICAL DR
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City | TITUSVILLE
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State | FL
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Zip | 32796-2142
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Country | US
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Telephone | 321-269-0748
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Fax | 321-383-2424
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Provider Business Mailing Address
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Address Line | 875 CENTURY MEDICAL DR
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City | TITUSVILLE
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State | FL
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Zip | 32796-2142
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Country | US
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Telephone | 321-269-0748
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Fax | 321-383-2424
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Authorized Official
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Title or Position | PROVIDER
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Name | DR. TANYA ITANI TAIVAL
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Credential | D.O.
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Telephone | 321-269-0748
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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