Provider Demographics
NPI:1508351842
Name:TAMAYO-CONTRERAS, SHIRLEY LESLEY
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:LESLEY
Last Name:TAMAYO-CONTRERAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2570
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92202-3370
Mailing Address - Country:US
Mailing Address - Phone:760-574-9013
Mailing Address - Fax:
Practice Address - Street 1:333 S FARRELL DR
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-7905
Practice Address - Country:US
Practice Address - Phone:760-416-1360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-28
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
19970503763500OtherMEDICAL/IEHP