Provider Demographics
NPI:1528398633
Name:PEREZ, TAMMARA LYNNETTE (LMP)
Entity Type:Individual
Prefix:
First Name:TAMMARA
Middle Name:LYNNETTE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:TAMI
Other - Middle Name:L
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMP
Mailing Address - Street 1:PO BOX 8051
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-0051
Mailing Address - Country:US
Mailing Address - Phone:509-469-1903
Mailing Address - Fax:509-469-1905
Practice Address - Street 1:3907 SUMMITVIEW AVE
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-2716
Practice Address - Country:US
Practice Address - Phone:509-966-1640
Practice Address - Fax:509-469-1905
Is Sole Proprietor?:No
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60070706225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist