Provider Demographics
NPI:1417074915
Name:DINH, TAM MARISA (NP)
Entity Type:Individual
Prefix:MRS
First Name:TAM
Middle Name:MARISA
Last Name:DINH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 PEACH ST. APT. A
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91755
Mailing Address - Country:US
Mailing Address - Phone:626-485-8089
Mailing Address - Fax:
Practice Address - Street 1:1153 S GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-4714
Practice Address - Country:US
Practice Address - Phone:626-281-1961
Practice Address - Fax:626-281-6564
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA525606363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily