Provider Demographics
NPI:1689809840
Name:DAN B TARANGO D P M INC
Entity Type:Organization
Organization Name:DAN B TARANGO D P M INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:TARANGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-461-2990
Mailing Address - Street 1:8875 LA MESA BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-5100
Mailing Address - Country:US
Mailing Address - Phone:619-461-2990
Mailing Address - Fax:619-461-7959
Practice Address - Street 1:8875 LA MESA BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-5100
Practice Address - Country:US
Practice Address - Phone:619-461-2990
Practice Address - Fax:619-461-7959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1308213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty