| Antonio A. Tan, Md, Professional Corporation | |
|
12980 Frederick St Suite D Moreno Valley CA 92553-5263 | |
| (951) 485-2744 | |
| (951) 485-2749 |
| Full Name | Antonio A. Tan, Md, Professional Corporation |
|---|---|
| Speciality | Clinic/Center |
| Location | 12980 Frederick St, Moreno Valley, California |
| Authorized Official Name and Position | Rhoda J. Tan (MANAGER / SECRETARY OF P.C.) |
| Authorized Official Contact | 9514852744 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Antonio A. Tan, Md, Professional Corporation 12980 Frederick St Suite D Moreno Valley CA 92553-5263 Ph: (951) 485-2744 | Antonio A. Tan, Md, Professional Corporation 12980 Frederick St Suite D Moreno Valley CA 92553-5263 Ph: (951) 485-2744 |
| NPI Number | 1003870676 |
|---|---|
| Provider Enumeration Date | 04/12/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 9133177306 |
|---|---|
| Medicare Enrollment ID | O20050105000392 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003870676 | NPI | - | NPPES |
| 00A454161 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | A45416 (California) | Primary |
| Provider Name | Antonio Tan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1134277569 PECOS PAC ID: 9032188446 Enrollment ID: I20050106000207 |
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