Provider Demographics
NPI:1235160003
Name:TANNOUS, ZIAD (MD)
Entity Type:Individual
Prefix:
First Name:ZIAD
Middle Name:
Last Name:TANNOUS
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:PO BOX 5047
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92263
Mailing Address - Country:US
Mailing Address - Phone:760-323-4416
Mailing Address - Fax:760-323-2668
Practice Address - Street 1:1180 N INDIAN CANYON ROAD
Practice Address - Street 2:SUITE #208W
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262
Practice Address - Country:US
Practice Address - Phone:760-323-4416
Practice Address - Fax:760-323-2668
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54040207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A540400Medicaid
CA00A540400Medicare PIN
CA00A540400Medicaid