MEDICARE: DR. MANUEL TANGUMA III M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	A101646	CA

General Provider Information

NPI Number	:	1659368363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MANUEL TANGUMA III M.D.

Provider Business Mailing Address
First Line	:	3220 MISSION AVE
Second Line	:	UNIT 1
City	:	OCEANSIDE
State	:	CA
Zip	:	92058-1351
Country	:	US
Telephone Number	:	760-736-6767
Fax Number	:

Provider Business Practice Location Address
First Line	:	3220 MISSION AVE
Second Line	:	UNIT 1
City	:	OCEANSIDE
State	:	CA
Zip	:	92058-1351
Country	:	US
Telephone Number	:	760-736-6767
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	03/02/2016

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