Provider Demographics
NPI:1790080810
Name:VASHISTHA, TANIA (MD)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:VASHISTHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TANIA
Other - Middle Name:
Other - Last Name:SHARMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:130 RAMPART WAY
Mailing Address - Street 2:STE 300B
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-6451
Mailing Address - Country:US
Mailing Address - Phone:303-327-4700
Mailing Address - Fax:303-327-4711
Practice Address - Street 1:11165 SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1113
Practice Address - Country:US
Practice Address - Phone:818-365-9531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-20
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0056230207RN0300X
CAA115713207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A1157130Medicaid
CAGA194YMedicare PIN