Active NPI
Venus Eugenio Tanzo
- Pediatrics Physician
- Perris, CA
National Provider Identifier
1649296146
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- C51018
- Practice address
- 498 W 4TH St
Perris, CA 92570-2070 - Phone
- (951) 943-8899
- Fax
- (951) 943-4598
- NPI assigned
- Jul 15, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | C51018 | CA | Primary |
Addresses
Primary practice location
498 W 4TH St
Perris, CA 92570-2070
Mailing address
498 W 4TH St
Perris, CA 92570-2070
Phone (951) 943-8899
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| FHC70593F | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C51018 | CA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Reuben C Castillo, Professional Corporation | Past | Accepting new patients | |
| Community Health Centers of the Central Coast Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Federally Qualified Health Center (FQHC)
- Morro Bay, CA
- NPI 1841217882
-
- General Practice Physician
- Perris, CA
- NPI 1942429188
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152921600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1583107200000",
"number": "1649296146",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "498 W 4TH ST",
"city": "PERRIS",
"state": "CA",
"postal_code": "925702070",
"telephone_number": "951-943-8899",
"fax_number": "951-943-4598"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "498 W 4TH ST",
"city": "PERRIS",
"state": "CA",
"postal_code": "925702070",
"telephone_number": "951-943-8899",
"fax_number": "951-943-4598"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TANZO",
"first_name": "VENUS",
"middle_name": "EUGENIO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-15",
"last_updated": "2020-03-02",
"certification_date": "2020-03-02",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "C51018",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "FHC70593F",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Perris, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.