Provider Demographics
NPI:1295962686
Name:TANAKA, MARY SAPH (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:SAPH
Last Name:TANAKA
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 1:3257 CAMINO DE LOS COCHES STE 202
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-8915
Mailing Address - Country:US
Mailing Address - Phone:760-633-3640
Mailing Address - Fax:
Practice Address - Street 1:3257 CAMINO DE LOS COCHES STE 202
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-8915
Practice Address - Country:US
Practice Address - Phone:760-633-3640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-12
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA116057208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty