Provider Demographics
NPI:1053337097
Name:MANTUA, TANIA M (OD)
Entity type:Individual
Prefix:DR
First Name:TANIA
Middle Name:M
Last Name:MANTUA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7075 REDWOOD BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-4136
Mailing Address - Country:US
Mailing Address - Phone:415-897-2997
Mailing Address - Fax:415-898-3626
Practice Address - Street 1:7075 REDWOOD BLVD STE F
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-4136
Practice Address - Country:US
Practice Address - Phone:415-897-2997
Practice Address - Fax:415-898-3626
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA9487T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist