Provider Demographics
NPI:1588850721
Name:ONGLAO, ART TABLAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ART
Middle Name:TABLAN
Last Name:ONGLAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ARTURO
Other - Middle Name:TABLAN
Other - Last Name:ONGLAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1600 9TH STREET, ROOM 150
Mailing Address - Street 2:FISCAL ALLOCATIONS AND ESTIMATES UNIT
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95814-6414
Mailing Address - Country:US
Mailing Address - Phone:916-651-9475
Mailing Address - Fax:916-654-8908
Practice Address - Street 1:10333 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-5808
Practice Address - Country:US
Practice Address - Phone:805-468-2000
Practice Address - Fax:805-468-6011
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64171207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine