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NPI Code Detail

MEDICARE: DR. TASHA MANTERNACH M.D.

MEDICARE: DR. TASHA MANTERNACH 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
1207N00000XDermatology PhysicianC52681CA

General Provider Information

NPI Number : 1750360491
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TASHA MANTERNACH M.D.
Provider Business Mailing Address
First Line : 141 ATHENA ST
Second Line :
City : ENCINITAS
State : CA
Zip : 92024-2026
Country : US
Telephone Number : 760-828-2093
Fax Number :
Provider Business Practice Location Address
First Line : 1300 RANCHO DEL ORO RD
Second Line :
City : OCEANSIDE
State : CA
Zip : 92056-1729
Country : US
Telephone Number : 760-828-2093
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/11/2006
Last Update Date : 02/10/2012

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