Provider Demographics
NPI:1316570278
Name:AMOS, TAMIKO (LVN)
Entity Type:Individual
Prefix:
First Name:TAMIKO
Middle Name:
Last Name:AMOS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 E HIGHLAND CT
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-1627
Mailing Address - Country:US
Mailing Address - Phone:909-545-0882
Mailing Address - Fax:
Practice Address - Street 1:1920 E HIGHLAND CT
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-1627
Practice Address - Country:US
Practice Address - Phone:909-545-0882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA704069164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse