Provider Demographics
NPI:1528185055
Name:TISON MEDICAL GROUP INC
Entity Type:Organization
Organization Name:TISON MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:H
Authorized Official - Last Name:TISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-949-5955
Mailing Address - Street 1:44241 15TH ST W
Mailing Address - Street 2:SUITE NO. 201
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-4037
Mailing Address - Country:US
Mailing Address - Phone:661-949-5955
Mailing Address - Fax:661-949-5958
Practice Address - Street 1:801 N TUSTIN AVE
Practice Address - Street 2:SUITE NO. 500
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3612
Practice Address - Country:US
Practice Address - Phone:714-550-7700
Practice Address - Fax:714-550-7074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP 16664174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty