Provider Demographics
NPI:1306879036
Name:TABBAA, MUMTAZ G (MD)
Entity type:Individual
Prefix:DR
First Name:MUMTAZ
Middle Name:G
Last Name:TABBAA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:395 DEL MONTE CTR STE 173
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-6156
Mailing Address - Country:US
Mailing Address - Phone:831-755-4111
Mailing Address - Fax:831-372-1666
Practice Address - Street 1:1441 CONSTITUTION BLVD
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-3100
Practice Address - Country:US
Practice Address - Phone:831-755-4111
Practice Address - Fax:831-755-4087
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2018-03-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA54688207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSP40248FMedicaid
CAHSP40248FMedicaid
CAA54688Medicare UPIN