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General NPI Number Information
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NPI Number | 1285952655
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Entity Type | Individual
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Provider Name | OLIVER O TANNOUS M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/11/2010
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Last Update Date | 12/11/2015
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Provider Practice Location Address
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Address Line | 350 DICKINSON ST SUITE 121, MC 8894
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City | SAN DIEGO
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State | CA
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Zip | 92103-1913
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Country | US
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Telephone | 858-248-6456
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Fax |
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Provider Business Mailing Address
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Address Line | 350 DICKINSON STREET SUITE 121
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City | SAN DIEGO
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State | CA
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Zip | 92103
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Country | US
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Telephone | 858-248-6456
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | A134817
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207XX0801X
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Taxonomy Name | Orthopaedic Trauma Physician
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License Number | A134817
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License Number State | CA
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