Provider Demographics
NPI:1336131911
Name:TARANGO, DAN B (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:B
Last Name:TARANGO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8851 CENTER DR
Mailing Address - Street 2:#201
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3017
Mailing Address - Country:US
Mailing Address - Phone:619-461-2990
Mailing Address - Fax:619-461-7959
Practice Address - Street 1:8851 CENTER DR
Practice Address - Street 2:#201
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3017
Practice Address - Country:US
Practice Address - Phone:619-461-2990
Practice Address - Fax:619-461-7959
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000378213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT19091Medicare UPIN