Provider Demographics
NPI:1992907190
Name:TANK, JOSIAH MICAH (HEALTH SERVIC TECH)
Entity type:Individual
Prefix:MR
First Name:JOSIAH
Middle Name:MICAH
Last Name:TANK
Suffix:
Gender:M
Credentials:HEALTH SERVIC TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 EAGLE RD
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-5100
Mailing Address - Country:US
Mailing Address - Phone:510-437-3582
Mailing Address - Fax:510-437-3611
Practice Address - Street 1:1 EAGLE RD
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-5100
Practice Address - Country:US
Practice Address - Phone:510-437-3582
Practice Address - Fax:510-437-3611
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other