Provider Demographics
NPI:1144396383
Name:TAMAYO, BEATRIZ (MD)
Entity Type:Individual
Prefix:DR
First Name:BEATRIZ
Middle Name:
Last Name:TAMAYO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3909
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-9541
Mailing Address - Country:US
Mailing Address - Phone:213-250-0050
Mailing Address - Fax:213-250-0150
Practice Address - Street 1:1127 WILSHIRE BLVD STE 202
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-3903
Practice Address - Country:US
Practice Address - Phone:213-250-0050
Practice Address - Fax:213-250-0150
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74662207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A746620Medicaid
CAWA74662AMedicare PIN
CAWA74662CMedicare PIN
CAWA74662BMedicare PIN
CAWA74662EMedicare PIN
H57576Medicare UPIN
CA00A746620Medicaid
CAWA74662FMedicare PIN