Provider Demographics
NPI:1033531652
Name:JOYCE TATELMAN MD, INC.
Entity Type:Organization
Organization Name:JOYCE TATELMAN MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:TATELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-528-5110
Mailing Address - Street 1:2204 GRANT RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-3855
Mailing Address - Country:US
Mailing Address - Phone:650-528-5110
Mailing Address - Fax:650-528-5115
Practice Address - Street 1:2204 GRANT RD
Practice Address - Street 2:SUITE 104
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-3855
Practice Address - Country:US
Practice Address - Phone:650-528-5110
Practice Address - Fax:650-528-5115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-16
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60885261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG63517Medicare UPIN