Provider Demographics
NPI:1346002508
Name:SIMBRA, TANYA
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:SIMBRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8871 SPECTRUM CENTER BLVD APT 10216
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1476
Mailing Address - Country:US
Mailing Address - Phone:510-589-0782
Mailing Address - Fax:
Practice Address - Street 1:8871 SPECTRUM CENTER BLVD APT 10216
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1476
Practice Address - Country:US
Practice Address - Phone:510-589-0782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95026757363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily