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General NPI Number Information
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NPI Number | 1013516707
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Entity Type | Organization
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Legal Business Name | TANYA M. PHARES, DO, MPH
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Dates
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Enumeration Date | 10/22/2020
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Last Update Date | 10/22/2020
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Provider Practice Location Address
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Address Line | 369 SAN MIGUEL DR STE 200
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-7850
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Country | US
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Telephone | 949-423-3530
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Fax |
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Provider Business Mailing Address
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Address Line | 406 ORCHID AVE, #1073
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City | CORONA DEL MAR
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State | CA
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Zip | 92625
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Country | US
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Telephone | 949-423-3530
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Fax |
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Authorized Official
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Title or Position | CEO/PHYSICIAN
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Name | TANYA PHARES
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Credential | DO, MPH
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Telephone | 949-423-3530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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