Provider Demographics
NPI:1558443648
Name:TATUM, VANESSA DENISE (MD)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:DENISE
Last Name:TATUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 918
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92842-0918
Mailing Address - Country:US
Mailing Address - Phone:714-530-4489
Mailing Address - Fax:714-530-9917
Practice Address - Street 1:10281 CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-2944
Practice Address - Country:US
Practice Address - Phone:714-530-4489
Practice Address - Fax:714-530-9917
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG49258207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine