Basic Information
| Provider Information | |||||||||
| NPI: | 1093762833 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAAGDENBERG | ||||||||
| FirstName: | TANYA | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | POPOVA | ||||||||
| OtherFirstName: | TANYA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 77 CADILLAC DR | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958255453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9169202082 | ||||||||
| FaxNumber: | 9169201430 | ||||||||
| Practice Location | |||||||||
| Address1: | 77 CADILLAC DR | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958255453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9169202082 | ||||||||
| FaxNumber: | 9169201430 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | A88493 | CA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.