Provider Demographics
NPI:1346003118
Name:TAM, CALIDA (PA-C)
Entity Type:Individual
Prefix:
First Name:CALIDA
Middle Name:
Last Name:TAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7684 PIONEER RANCH AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-3074
Mailing Address - Country:US
Mailing Address - Phone:702-334-5492
Mailing Address - Fax:
Practice Address - Street 1:7280 W AZURE DR STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-4401
Practice Address - Country:US
Practice Address - Phone:725-248-2244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical