Provider Demographics
NPI:1699441303
Name:PREVENTIVE MEDICINE CONSULTING, LLC
Entity type:Organization
Organization Name:PREVENTIVE MEDICINE CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PHARES
Authorized Official - Suffix:
Authorized Official - Credentials:DO, MPH
Authorized Official - Phone:530-539-4121
Mailing Address - Street 1:PO BOX 19115
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-0889
Mailing Address - Country:US
Mailing Address - Phone:530-539-4121
Mailing Address - Fax:
Practice Address - Street 1:15 MCCABE DR STE 203
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-4816
Practice Address - Country:US
Practice Address - Phone:530-539-4121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-22
Last Update Date:2021-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1396078002OtherNPI