Basic Information
| Provider Information | |||||||||
| NPI: | 1457474033 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ARENE | ||||||||
| FirstName: | TAGBO | ||||||||
| MiddleName: | EKENE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD, MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 303 E. VANDERBILT WAY | ||||||||
| Address2: | COUNTY OF SAN BERNARDINO, DBH | ||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9093880810 | ||||||||
| FaxNumber: | 9098900281 | ||||||||
| Practice Location | |||||||||
| Address1: | 303 E VANDERBILT WAY COUNTY OF SAN BERNARDINO DBH | ||||||||
| Address2: | |||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924152804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9093880810 | ||||||||
| FaxNumber: | 9098900281 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2007 | ||||||||
| LastUpdateDate: | 06/22/2017 | ||||||||
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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 | 2084P0800X | A139396 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 139396 | 01 | CA | MEDICAL BOARD OF CALIFORNIA (PHYSICIAN & SURGEON A LICENSE) | OTHER |