Provider Demographics
NPI:1386291565
Name:TANKOUO SANDJONG, BERTRAND (PHD, D(ABMM))
Entity type:Individual
Prefix:DR
First Name:BERTRAND
Middle Name:
Last Name:TANKOUO SANDJONG
Suffix:
Gender:M
Credentials:PHD, D(ABMM)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5117 34TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-2304
Mailing Address - Country:US
Mailing Address - Phone:831-235-8266
Mailing Address - Fax:806-993-2000
Practice Address - Street 1:5117 34TH ST STE B
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-2304
Practice Address - Country:US
Practice Address - Phone:831-235-8266
Practice Address - Fax:806-993-2000
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1256247ZC0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician