Provider Demographics
NPI:1588008262
Name:TAVAI, TAMARA
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:TAVAI
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 1:13 SCOTTSDALE N
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-5659
Mailing Address - Country:US
Mailing Address - Phone:562-206-6207
Mailing Address - Fax:
Practice Address - Street 1:603 W 231ST ST
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-4617
Practice Address - Country:US
Practice Address - Phone:310-427-2573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-24
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA225400000XOtherMH REHABILITATION SPECIALIST
CA171M00000XOtherCASE MANAGER