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1457553885
MICHAEL TANNENBAUM
MODESTO, CA
NPI
1457553885
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: OR PA01230)
Enumeration Date
2007-06-05
Last Update Date
2009-06-12
Business Address
MICHAEL TANNENBAUM PA
1808 SCENIC DR APT 107
MODESTO, CA 95355
Phone number: 510-409-8966
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Mailing Address
MICHAEL TANNENBAUM PA
1808 SCENIC DR APT 107
MODESTO, CA 95355-4947
Phone number: 510-409-8966
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