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General NPI Number Information
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NPI Number | 1518342799
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Entity Type | Individual
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Provider Name | ROSE KRISTINE DE GUZMAN TIANGCO M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/29/2015
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Last Update Date | 09/13/2023
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Provider Practice Location Address
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Address Line | 2500 N STATE ST
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City | JACKSON
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State | MS
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Zip | 39216-4500
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Country | US
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Telephone | 601-815-2869
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Fax | 601-815-9356
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Provider Business Mailing Address
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Address Line | 504 CLINTON CENTER DR STE 4300
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City | CLINTON
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State | MS
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Zip | 39056-5610
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Country | US
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Telephone | 601-815-2005
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Fax | 601-815-0434
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 63576
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 70639
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 31380
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License Number State | MS
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