Provider Demographics
NPI:1013171230
Name:TAGANAS, ANDRELEE G (MD)
Entity Type:Individual
Prefix:
First Name:ANDRELEE
Middle Name:G
Last Name:TAGANAS
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 1:3266 STRATFORD AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-2483
Mailing Address - Country:US
Mailing Address - Phone:419-376-9323
Mailing Address - Fax:
Practice Address - Street 1:2295 S VINEYARD AVE STE A
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-7926
Practice Address - Country:US
Practice Address - Phone:909-427-7132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA115620207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine