Provider Demographics
NPI:1467882456
Name:ROLAN, TAMARA M (CNM)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:M
Last Name:ROLAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4140 W 190TH ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-5513
Mailing Address - Country:US
Mailing Address - Phone:310-967-8625
Mailing Address - Fax:310-423-0140
Practice Address - Street 1:8635 W 3RD ST STE 160W
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-6103
Practice Address - Country:US
Practice Address - Phone:310-967-8625
Practice Address - Fax:310-423-0140
Is Sole Proprietor?:No
Enumeration Date:2013-11-12
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDGCNM26137A367A00000X
CA236293367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife