Tatiana Marie Mamantov in Modesto - Emergency Medicine
Tatiana Marie Mamantov - NPI 1629069059
Tatiana Marie Mamantov is a Emergency Medicine in Modesto, California. Tatiana Marie Mamantov practices all healthcare services and medical treatments related to Emergency Medicine. The NPI Number for Tatiana Marie Mamantov is 1629069059. The last update date is 2008-07-30.
Tatiana Marie Mamantov's current location address is 4301 Northstar Way, Modesto, California. You can contact this provider via phone number 2093422300 and fax number 2095244240. The mailing address for Tatiana Marie Mamantov is 4301 Northstar Way, Modesto, California. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Tatiana Marie Mamantov |
|---|---|
| Address | 4301 Northstar Way, Modesto, California |
| Phone Number | 2093422300 |
| Fax Number | 2095244240 |
| Sole Proprietor | N |
| Credentials | MD |
NPI Number Detail
| NPI Number | 1629069059 |
|---|---|
| Provider Enumeration Date | 2005-11-03 |
| Last Updated Date | 2008-07-30 |
Provider Mailing Address Detail
| Address | 4301 Northstar Way |
|---|---|
| City | Modesto |
| State | California (CA) |
| Post Code | 953569262 |
| Phone Number | 2093422300 |
| Fax Number | 2095244240 |
Provider's Primary Taxonomy Detail
| Speciality | Emergency Medicine |
|---|---|
| Taxonomy | 207P00000X |
| Licence No | G85179 |
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Definition: An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 00G851790 | CA | BLUE SHIELD | |
| 00G851790 | CA | -- |
Post Comment/ Review Below
What is the unique identification code assigned to Tatiana Marie Mamantov by the Centers for Medicare & Medicaid Services?
The Tatiana Marie Mamantov has been issued the NPI (National Provider Identifier) 1629069059. This 10-digit code serves as a unique identifier for healthcare providers, assigned by the Centers for Medicare & Medicaid Services (CMS).
Could you share the physical location details of Tatiana Marie Mamantov?
The Tatiana Marie Mamantov is situated at 4301 Northstar Way, in the city of Modesto, state of CA, with the zip code 953569262.
What is Tatiana Marie Mamantov's specialized field of practice, and what is the corresponding taxonomy classification code?
The Tatiana Marie Mamantov's area of specialization is Emergency Medicine, and the corresponding taxonomy code that categorizes this field of practice is 207P00000X.
When did the Tatiana Marie Mamantov receive its 1629069059?
The Tatiana Marie Mamantov was issued its 1629069059 on 2005-11-03, which is the date when the organization was assigned this unique identifier.
As of what date were the details related to Tatiana Marie Mamantov most recently updated or revised?
The information pertaining to Tatiana Marie Mamantov, including its address, specialty, and other relevant details, was last updated or revised on 2008-07-30.