Provider Demographics
NPI:1790869139
Name:TATE, ERIC MARIO (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:MARIO
Last Name:TATE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:16660 PARAMOUNT BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-5458
Mailing Address - Country:US
Mailing Address - Phone:562-531-3133
Mailing Address - Fax:562-531-3204
Practice Address - Street 1:16660 PARAMOUNT BLVD STE 205
Practice Address - Street 2:
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-5458
Practice Address - Country:US
Practice Address - Phone:562-531-3133
Practice Address - Fax:562-531-3204
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2020-05-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA75199207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH94128Medicare UPIN