Mark Tambellini, M.D.

Primary specialty

Adult Medicine PhysicianTaxonomy code 207QA0505X

License

G37599 Issued in CA

Practice address

5021 Brower CT
Granite Bay, CA 95746-6742

Phone

(916) 761-9399

Fax

(916) 774-4360

NPI assigned

Sep 28, 2010

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1285632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285632000000",
    "number": "1902115793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5021 BROWER CT",
            "city": "GRANITE BAY",
            "state": "CA",
            "postal_code": "957466742",
            "telephone_number": "916-761-9399",
            "fax_number": "916-774-4360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5021 BROWER CT",
            "city": "GRANITE BAY",
            "state": "CA",
            "postal_code": "957466742",
            "telephone_number": "916-761-9399",
            "fax_number": "916-774-4360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAMBELLINI",
        "first_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-09-28",
        "last_updated": "2010-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "CA",
            "license": "G37599",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL BOARD OF CALIFORNIA",
            "identifier": "G37599",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Adult Medicine Physician in Granite Bay, CA
• Providers in Granite Bay, CA by specialty
• Adult Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.