Provider Demographics
NPI:1649869124
Name:NATASHA TANBAKUCHI. INC
Entity type:Organization
Organization Name:NATASHA TANBAKUCHI. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:SARAH
Authorized Official - Last Name:TANBAKUCHI
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:954-551-9678
Mailing Address - Street 1:800 E BROWARD BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2024
Mailing Address - Country:US
Mailing Address - Phone:954-551-9678
Mailing Address - Fax:
Practice Address - Street 1:800 E BROWARD BLVD STE 300
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2024
Practice Address - Country:US
Practice Address - Phone:954-551-9678
Practice Address - Fax:954-337-7683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center