Provider Demographics
NPI:1225175862
Name:TANADA, GERALDINE
Entity Type:Individual
Prefix:DR
First Name:GERALDINE
Middle Name:
Last Name:TANADA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12212 FAIRBURN WAY
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-5805
Mailing Address - Country:US
Mailing Address - Phone:805-483-9586
Mailing Address - Fax:714-571-3560
Practice Address - Street 1:455 S C ST
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-5917
Practice Address - Country:US
Practice Address - Phone:805-483-9586
Practice Address - Fax:805-483-1486
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44098122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD44098Medicaid