Provider Demographics
NPI:1578292033
Name:TAMINANG, CARLSON (RN)
Entity Type:Individual
Prefix:
First Name:CARLSON
Middle Name:
Last Name:TAMINANG
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20148 N DONITHAN WAY
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-2428
Mailing Address - Country:US
Mailing Address - Phone:480-516-8103
Mailing Address - Fax:
Practice Address - Street 1:20148 N DONITHAN WAY
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-2428
Practice Address - Country:US
Practice Address - Phone:480-516-8103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility