Provider Demographics
NPI:1013516707
Name:TANYA M. PHARES, DO, MPH
Entity Type:Organization
Organization Name:TANYA M. PHARES, DO, MPH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHARES
Authorized Official - Suffix:
Authorized Official - Credentials:DO, MPH
Authorized Official - Phone:949-423-3530
Mailing Address - Street 1:406 ORCHID AVE, #1073
Mailing Address - Street 2:
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625
Mailing Address - Country:US
Mailing Address - Phone:949-423-3530
Mailing Address - Fax:
Practice Address - Street 1:369 SAN MIGUEL DR STE 200
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7850
Practice Address - Country:US
Practice Address - Phone:949-423-3530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty