Provider Demographics
NPI:1467450676
Name:TONGSON, ROBERTO CAZAR (MD)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:CAZAR
Last Name:TONGSON
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 1:212 BASSETT ST
Mailing Address - Street 2:
Mailing Address - City:KING CITY
Mailing Address - State:CA
Mailing Address - Zip Code:93930-2943
Mailing Address - Country:US
Mailing Address - Phone:831-386-9542
Mailing Address - Fax:831-386-0864
Practice Address - Street 1:212 BASSETT ST
Practice Address - Street 2:
Practice Address - City:KING CITY
Practice Address - State:CA
Practice Address - Zip Code:93930-2943
Practice Address - Country:US
Practice Address - Phone:831-386-9542
Practice Address - Fax:831-386-0864
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A54183174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A541831Medicaid
CA00A541831Medicaid
CA00A541830Medicare ID - Type Unspecified