Basic Information
| Provider Information | |||||||||
| NPI: | 1134157860 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TANAKA | ||||||||
| FirstName: | NILS | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1403 | ||||||||
| Address2: | |||||||||
| City: | SUMMERLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930671403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055653231 | ||||||||
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| Practice Location | |||||||||
| Address1: | 700 ALAMO PINTADO RD | ||||||||
| Address2: | |||||||||
| City: | SOLVANG | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934632269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056886431 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 10/31/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | G57654 | CA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207R00000X | G57654 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.