Provider Demographics
NPI:1366494320
Name:TANASESCU, ADINA (MD)
Entity Type:Individual
Prefix:DR
First Name:ADINA
Middle Name:
Last Name:TANASESCU
Suffix:
Gender:F
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 54130
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90054-0130
Mailing Address - Country:US
Mailing Address - Phone:951-687-3400
Mailing Address - Fax:951-687-7630
Practice Address - Street 1:3660 PARK SIERRA DR
Practice Address - Street 2:SUITE 208
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-3081
Practice Address - Country:US
Practice Address - Phone:951-687-2800
Practice Address - Fax:951-687-7290
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66943207RN0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0092370OtherMEDICAL GRP #
CAZZZ22408ZOtherNORTHERN MEDICARE GRP #
CA00A669430OtherMEDICARE IDENTIFICATION N
CAWA66943AOtherMEDICARE IDENTIFICATION N
CAW1985OtherSOUTHERN MEDICARE GRP #
CAH63135Medicare UPIN