Mamantov, Tatiana Marie

Mamantov, Tatiana Marie is an individual health care provider with primary practice located at 20103 Lake Chabot Rd , Castro Valley CA 94546-5341. She recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as her primary health care specialty. Mamantov, Tatiana Marie can be contacted via phone (209) 342-2300.

Contact Information

Primary practice address
20103 Lake Chabot Rd Castro Valley CA 94546-5341
Phone: (209) 342-2300
Fax: (209) 524-4240
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X G85179 California

Profile Details

NPI number 1629069059
LBN Legal business name Mamantov, Tatiana Marie
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 3rd, 2005
Last updated Jul 30th, 2008 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1629069059 NPPES
California Other 00G851790 BLUE SHIELD
California MEDICAID 00G851790 BLUE SHIELD

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