Provider Demographics
NPI:1073580320
Name:TAMALPAIS PEDIATRICS
Entity Type:Organization
Organization Name:TAMALPAIS PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-461-0440
Mailing Address - Street 1:5 BON AIR ROAD
Mailing Address - Street 2:STE. 105
Mailing Address - City:LARKSPUR
Mailing Address - State:CA
Mailing Address - Zip Code:94939
Mailing Address - Country:US
Mailing Address - Phone:415-461-0440
Mailing Address - Fax:415-461-3792
Practice Address - Street 1:5 BON AIR ROAD
Practice Address - Street 2:STE. 105
Practice Address - City:LARKSPUR
Practice Address - State:CA
Practice Address - Zip Code:94939
Practice Address - Country:US
Practice Address - Phone:415-461-0440
Practice Address - Fax:415-461-3792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty