Provider Demographics
NPI:1285653683
Name:VERDER, TINA BUERANO (MD)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:BUERANO
Last Name:VERDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9602
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91346-9602
Mailing Address - Country:US
Mailing Address - Phone:818-837-5637
Mailing Address - Fax:818-792-4793
Practice Address - Street 1:18411 CLARK ST
Practice Address - Street 2:SUITE 102
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3506
Practice Address - Country:US
Practice Address - Phone:877-503-0518
Practice Address - Fax:877-503-0520
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2014-03-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG71902207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G719020Medicaid
CAWG71902AMedicare PIN
CA00G719020Medicaid