Provider Demographics
NPI:1104836519
Name:HOOVER, TAMARA J (MD)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:J
Last Name:HOOVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1968 FLUME DR
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-3707
Mailing Address - Country:US
Mailing Address - Phone:619-401-8058
Mailing Address - Fax:619-401-8058
Practice Address - Street 1:1968 FLUME DR
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-3707
Practice Address - Country:US
Practice Address - Phone:619-401-8058
Practice Address - Fax:619-401-8058
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG74348207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G746480Medicaid
CAI05286Medicare UPIN
CAWG74348AMedicare ID - Type Unspecified