Provider Demographics
NPI:1346835923
Name:MENDEZ-YADRON, TAMARA ASHLEY (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:ASHLEY
Last Name:MENDEZ-YADRON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 BUCKINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-2987
Mailing Address - Country:US
Mailing Address - Phone:925-234-0155
Mailing Address - Fax:
Practice Address - Street 1:1000 CORPORATE DR
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33334-3634
Practice Address - Country:US
Practice Address - Phone:800-571-6511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA299993225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty