Provider Demographics
NPI:1235372376
Name:TANTAWI, DIYA H (MD, FACS)
Entity Type:Individual
Prefix:
First Name:DIYA
Middle Name:H
Last Name:TANTAWI
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74000 CNTY CLUB DR STE A2
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-1677
Mailing Address - Country:US
Mailing Address - Phone:760-666-6121
Mailing Address - Fax:
Practice Address - Street 1:74000 CNTY CLUB DR STE A2
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-1677
Practice Address - Country:US
Practice Address - Phone:760-666-6121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-18
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1262182086S0105X, 2086S0122X, 208200000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery