Basic Information
| Provider Information | |||||||||
| NPI: | 1679698229 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TIRKANITS | ||||||||
| FirstName: | BEATRIX | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD, FCSRC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1441 AVOCADO AVE | ||||||||
| Address2: | SUITE 308 | ||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926607721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9497210494 | ||||||||
| FaxNumber: | 9497214138 | ||||||||
| Practice Location | |||||||||
| Address1: | 1441 AVOCADO AVE | ||||||||
| Address2: | SUITE 308 | ||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926607721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9497210494 | ||||||||
| FaxNumber: | 9497214138 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | G49824 | CA | Y | Other Service Providers | Specialist |
No ID Information.