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1225743719 NPI number — LYDIA HENRY TANNER MD

NPI Number: 1225743719
Health Care Provider/Practitioner: LYDIA HENRY TANNER MD

Information about “1225743719” NPI (LYDIA HENRY TANNER MD) exists in 1225743719 in HTML format HTML  |  1225743719 in plain Text format TXT  |  1225743719 in PDF (Portable Document Format) PDF  |  1225743719 in an XML format XML  formats.

NPI Number : 1225743719 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1225743719",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "TANNER",
    "FirstName": "LYDIA",
    "MiddleName": "HENRY",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "HENRY",
    "OtherFirstName": "LYDIA",
    "OtherMiddleName": "MICHELLE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "MD",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1000 W TOWN AND COUNTRY RD UNIT 218",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ORANGE",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92868-5628",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "251-802-3590",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1201 W LA VETA AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ORANGE",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92868-4203",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "714-997-3000",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/18/2023",
    "LastUpdateDate": "08/12/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "208000000X",
        "TaxonomyName": "Pediatrics Physician",
        "LicenseNumber": "204326",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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