Provider Demographics
NPI:1154538023
Name:TANAGHO, AMAL B (MD)
Entity type:Individual
Prefix:DR
First Name:AMAL
Middle Name:B
Last Name:TANAGHO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:16152 BEACH BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647
Mailing Address - Country:US
Mailing Address - Phone:714-841-6772
Mailing Address - Fax:714-841-6775
Practice Address - Street 1:16152 BEACH BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3806
Practice Address - Country:US
Practice Address - Phone:714-841-6772
Practice Address - Fax:714-841-6775
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAC51476174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist