Provider Demographics
NPI:1467485474
Name:TARRAR, AYMEL JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:AYMEL
Middle Name:JOHN
Last Name:TARRAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPT 34929
Mailing Address - Street 2:P.O. BOX 39000
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94139-0001
Mailing Address - Country:US
Mailing Address - Phone:916-536-2420
Mailing Address - Fax:916-536-2401
Practice Address - Street 1:8001 MADISON AVE
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-7901
Practice Address - Country:US
Practice Address - Phone:916-536-2420
Practice Address - Fax:916-536-2401
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90212207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A902120Medicaid
CAI00533Medicare UPIN
CA00A902121Medicare PIN