Provider Demographics
NPI:1073648200
Name:TAN, DANILO T (MD)
Entity Type:Individual
Prefix:DR
First Name:DANILO
Middle Name:T
Last Name:TAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5030 CAMINO DE LA SIESTA
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3116
Mailing Address - Country:US
Mailing Address - Phone:858-373-2444
Mailing Address - Fax:619-260-6307
Practice Address - Street 1:5030 CAMINO DE LA SIESTA
Practice Address - Street 2:SUITE 208
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3116
Practice Address - Country:US
Practice Address - Phone:858-373-2444
Practice Address - Fax:619-260-6307
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74484207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR059973AOtherMEDICARE PORTABLE X-RAY
H30715Medicare UPIN
CAWA74484AMedicare PIN