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1750825295 NPI number — TANYA AUDREY MARGARET DEPORTO MD, PHD, MPH

NPI Number: 1750825295
Health Care Provider/Practitioner: TANYA AUDREY MARGARET DEPORTO MD, PHD, MPH

Information about “1750825295” NPI (TANYA AUDREY MARGARET DEPORTO MD, PHD, MPH) exists in 1750825295 in HTML format HTML  |  1750825295 in plain Text format TXT  |  1750825295 in PDF (Portable Document Format) PDF  |  1750825295 in an XML format XML  formats.

NPI Number : 1750825295 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1750825295",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DEPORTO",
    "FirstName": "TANYA",
    "MiddleName": "AUDREY MARGARET",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "MD, PHD, MPH",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "GRIFFITHS",
    "OtherFirstName": "TANYA",
    "OtherMiddleName": "AUDREY MARGARET",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "MD, PHD, MPH",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "PO BOX 315",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WILDOMAR",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92595-0315",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "26001 REDLANDS BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "REDLANDS",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92373-7762",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "909-825-7084",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/16/2016",
    "LastUpdateDate": "08/17/2020",
    "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": "2083P0901X",
        "TaxonomyName": "Public Health & General Preventive Medicine Physician",
        "LicenseNumber": "145547",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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