Doctor Name: | MR. MICHAEL VINCENT TANGE |
NPI Number: | 1841402567 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | C.P.O. |
License Number: | CPO01077 |
Business Practice Address: | 3855 Princeton Dr Santa Rosa, CA - 954057061 |
Business Phone Number: | 7075799570 |
Business Fax Number: | 7075794963 |
Mailing Address: | 3855 Princeton Dr, SANTA ROSA |
State: | CA |
Postal Code: | 954057061 |
Phone Number: | 7075799570 |
Fax Number: | 7075794963 |
NPI Enumeration Date: | 05/04/2007 |
NPI Last Update Date: | 07/11/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | CPO01077 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |