Provider Demographics
NPI:1174863971
Name:TAN, VERNA O (PA-C)
Entity type:Individual
Prefix:
First Name:VERNA
Middle Name:O
Last Name:TAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5314 ALAGRO CT
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-8728
Mailing Address - Country:US
Mailing Address - Phone:925-277-1300
Mailing Address - Fax:925-277-1897
Practice Address - Street 1:1074 MURRIETA BLVD
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4111
Practice Address - Country:US
Practice Address - Phone:925-443-0980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-15
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15319363AS0400X
CA15319363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant