Provider Demographics
NPI:1225114713
Name:TAMAYO, ROBERT ENRIQUEZ (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ENRIQUEZ
Last Name:TAMAYO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3525 PACIFIC COAST HWY
Mailing Address - Street 2:SUITE E
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6655
Mailing Address - Country:US
Mailing Address - Phone:310-325-7799
Mailing Address - Fax:310-325-7790
Practice Address - Street 1:3525 PACIFIC COAST HWY
Practice Address - Street 2:SUITE E
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6655
Practice Address - Country:US
Practice Address - Phone:310-325-7799
Practice Address - Fax:310-325-7790
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10737TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASDO107370Medicaid
CASDO107370Medicaid
CAW18580Medicare ID - Type Unspecified
CAU63789Medicare UPIN