Provider Demographics
NPI:1144223488
Name:HAROLD L. TARLETON, M.D., INC.
Entity Type:Organization
Organization Name:HAROLD L. TARLETON, M.D., INC.
Other - Org Name:TARLETON MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:L
Authorized Official - Last Name:TARLETON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-836-0708
Mailing Address - Street 1:39000 BOB HOPE DRIVE
Mailing Address - Street 2:SUITE K406
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3213
Mailing Address - Country:US
Mailing Address - Phone:760-836-0708
Mailing Address - Fax:760-776-4293
Practice Address - Street 1:39000 BOB HOPE DRIVE
Practice Address - Street 2:SUITE K406
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3213
Practice Address - Country:US
Practice Address - Phone:760-836-0708
Practice Address - Fax:760-776-4293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC32824207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C328240Medicaid
CA00C328240Medicaid
CAZZZ01052ZMedicare ID - Type Unspecified