Provider Demographics
NPI:1821160821
Name:HILD, TANNAZ GHASSEMI (MD)
Entity Type:Individual
Prefix:DR
First Name:TANNAZ
Middle Name:GHASSEMI
Last Name:HILD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3971 ASHWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-8820
Mailing Address - Country:US
Mailing Address - Phone:951-707-8031
Mailing Address - Fax:
Practice Address - Street 1:3971 ASHWOOD CIR
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-8820
Practice Address - Country:US
Practice Address - Phone:951-707-8031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91524208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics