Provider Demographics
NPI:1558823534
Name:AGUILAR, TAMARA BERNAL (CASE MANAGER)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:BERNAL
Last Name:AGUILAR
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:BERNAL
Other - Last Name:AGUILAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14508 NE 20TH AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-6418
Mailing Address - Country:US
Mailing Address - Phone:360-397-9211
Mailing Address - Fax:
Practice Address - Street 1:13300 NE 44TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-6909
Practice Address - Country:US
Practice Address - Phone:503-891-4922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60801202171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator