Antonio a. Tan, MD, Professional Corporation

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

A45416 Issued in CA

Legal business name

ANTONIO A. TAN, MD, PROFESSIONAL CORPORATION

Practice address

12980 Frederick St
Suite D
Moreno Valley, CA 92553-5263

Phone

(951) 485-2744

Fax

(951) 485-2749

NPI assigned

Apr 12, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Rhoda J. Tan, RHIA

Title

Manager / Secretary of P.C.

Phone

(951) 485-2744

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Tax ID family

Antonio a Tan MD Professional Corporation2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Tri - State Medical Group, Inc.

  • Non-Pharmacy Dispensing Site
  • Midland, PA
  • NPI 1720129943
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Antonio A. Tan, M.D.

  • Internal Medicine Physician
  • Moreno Valley, CA
  • NPI 1134277569
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144800000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1003870676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12980 FREDERICK ST",
            "address_2": "SUITE D",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925535263",
            "telephone_number": "951-485-2744",
            "fax_number": "951-485-2749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12980 FREDERICK ST",
            "address_2": "SUITE D",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925535263",
            "telephone_number": "951-485-2744",
            "fax_number": "951-485-2749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANTONIO A. TAN, MD, PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TAN",
        "authorized_official_first_name": "RHODA",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "MANAGER / SECRETARY OF P.C.",
        "authorized_official_telephone_number": "951-485-2744",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RHIA"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CA",
            "license": "A45416",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A454161",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tanzila Anis
• Elizabeth Mawuena Ansah
• Shaista Ansari
• Anthony T. Fenison MD Inc
• Gabrielle J Antillon
• Jason Clay Antonio, D.D.S.
• Ap Mobility Inc
• Apindustrie Transportation
• Apple Urgent Care, Inc (Apple Urgent Care - Moreno Valley)
• Applied Behavior Autism Center LLC

• Clinic/Center in Moreno Valley, CA
• Providers in Moreno Valley, CA by specialty
• Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.