Provider Demographics
NPI:1568655306
Name:TOOHEY, TARA PUNDIAK (MD)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:PUNDIAK
Last Name:TOOHEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:MARIE
Other - Last Name:PUNDIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:941 ORANGE AVE # 315
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-2609
Mailing Address - Country:US
Mailing Address - Phone:808-352-3979
Mailing Address - Fax:
Practice Address - Street 1:641 CORONADO AVE
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-2031
Practice Address - Country:US
Practice Address - Phone:808-352-3979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD1874652084P0800X
NV187912084P0800X
DEC1-00104732084P0800X
HI155852084P0800X
NY2346472084P0800X
CAC1305192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry