Provider Demographics
NPI:1912105461
Name:POONAWALLA, TASNEEM A (MD)
Entity type:Individual
Prefix:DR
First Name:TASNEEM
Middle Name:A
Last Name:POONAWALLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TASNEEM
Other - Middle Name:
Other - Last Name:MOGRI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23101 SHERMAN PL STE 520
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-2029
Mailing Address - Country:US
Mailing Address - Phone:818-336-1853
Mailing Address - Fax:818-336-1852
Practice Address - Street 1:23101 SHERMAN PL STE 520
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307
Practice Address - Country:US
Practice Address - Phone:818-336-1853
Practice Address - Fax:818-336-1852
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50892-20207N00000X
CA133426207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI61010OtherDEAN HEALTH INSURANCE
WI61010OtherDEAN HEALTH INSURANCE
WI741501763Medicare PIN