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General NPI Number Information
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NPI Number | 1821020157
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Entity Type | Individual
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Provider Name | TARA ZANDVLIET M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 05/16/2023
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Provider Practice Location Address
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Address Line | 2525 CAMINO DEL RIO SOUTH SUITE 130, ROOM 3
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City | SAN DIEGO
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State | CA
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Zip | 92108-3718
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Country | US
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Telephone | 619-929-0032
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Fax | 208-728-8168
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Provider Business Mailing Address
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Address Line | 5694 MISSION CENTER RD # 602-362
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City | SAN DIEGO
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State | CA
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Zip | 92108-4355
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Country | US
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Telephone | 619-929-0032
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Fax | 208-728-8168
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A71646
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License Number State | CA
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