Provider Demographics
NPI:1841277837
Name:TANK, DANIELA (DO)
Entity type:Individual
Prefix:
First Name:DANIELA
Middle Name:
Last Name:TANK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5268 AMELIA DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95118
Mailing Address - Country:US
Mailing Address - Phone:763-245-3002
Mailing Address - Fax:
Practice Address - Street 1:1101 S. WINCHESTER BLVD.,
Practice Address - Street 2:N-267
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128
Practice Address - Country:US
Practice Address - Phone:763-245-3002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN45879207Q00000X
CA20A 9102207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine