Provider Demographics
NPI:1629061718
Name:TAHAN, MARVA (RPT)
Entity Type:Individual
Prefix:
First Name:MARVA
Middle Name:
Last Name:TAHAN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14506 W GRANITE VALLEY DR
Mailing Address - Street 2:#205
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-6010
Mailing Address - Country:US
Mailing Address - Phone:623-584-5626
Mailing Address - Fax:623-584-8998
Practice Address - Street 1:14506 W GRANITE VALLEY DR
Practice Address - Street 2:#205
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-6010
Practice Address - Country:US
Practice Address - Phone:623-584-5626
Practice Address - Fax:623-584-8998
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1444208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2Z4400OtherHEALTH NET
AZP00014175OtherRAILROAD MEDICARE
AZP0298960OtherBCBS AZ BLUECARD
AZ2Z4400OtherHEALTH NET
AZP00014175OtherRAILROAD MEDICARE