Provider Demographics
NPI:1124021936
Name:TASTO, JAMES P (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:TASTO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:6719 ALVARADO RD
Mailing Address - Street 2:STE 200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-5256
Mailing Address - Country:US
Mailing Address - Phone:619-229-3932
Mailing Address - Fax:619-582-2860
Practice Address - Street 1:6719 ALVARADO RD
Practice Address - Street 2:STE 200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-5256
Practice Address - Country:US
Practice Address - Phone:619-229-3932
Practice Address - Fax:619-582-2860
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2017-09-15
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Provider Licenses
StateLicense IDTaxonomies
CAG14672207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G146720Medicaid
CAWG14672DOtherMEDICARE ID
CAA39306Medicare UPIN
CAWG14672DMedicare PIN