Active NPI
Tara Zandvliet, M.D.
- Pediatrics Physician
- San Diego, CA
National Provider Identifier
1821020157
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- A71646
- Practice address
- 2525 Camino del Rio South
Suite 130, Room 3
San Diego, CA 92108-3718 - Phone
- (619) 929-0032
- Fax
- (208) 728-8168
- NPI assigned
- Jul 7, 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 | A71646 | CA | Primary |
Addresses
Primary practice location
2525 Camino del Rio South
Suite 130, Room 3
San Diego, CA 92108-3718
Mailing address
5694 Mission Center Rd # 602-362
San Diego, CA 92108-4355
Phone (619) 929-0032
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 27, 2015 through Jan 27, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 71646 | CA | MD | Pharmacist |
| A71646 | CA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152230400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1684195200000",
"number": "1821020157",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5694 MISSION CENTER RD # 602-362",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921084355",
"telephone_number": "619-929-0032",
"fax_number": "208-728-8168"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2525 CAMINO DEL RIO SOUTH",
"address_2": "SUITE 130, ROOM 3",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921083718",
"telephone_number": "619-929-0032",
"fax_number": "208-728-8168"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZANDVLIET",
"first_name": "TARA",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-07",
"last_updated": "2023-05-16",
"certification_date": "2023-05-16",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "A71646",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.