Provider Demographics
NPI:1336382126
Name:HERBERT D. TARLOW,MD INC. PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:HERBERT D. TARLOW,MD INC. PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:TARLOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-772-2210
Mailing Address - Street 1:215 N STATE COLLEGE BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-2913
Mailing Address - Country:US
Mailing Address - Phone:714-772-2210
Mailing Address - Fax:714-774-2826
Practice Address - Street 1:215 N STATE COLLEGE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-2913
Practice Address - Country:US
Practice Address - Phone:714-772-2210
Practice Address - Fax:714-774-2826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-09
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA28168261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care